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Severe Health Outcomes in Adults with Respiratory Syncytial Virus-associated Hospitalizations
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  • Connor Goldman,
  • William Sieling,
  • Luis Alba,
  • Raul Silverio Francisco,
  • Celibell Vargas,
  • Angela Barrett,
  • Matthew Phillips,
  • Lyn Finelli,
  • Lisa Saiman
Connor Goldman
Columbia University Irving Medical Center
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William Sieling
Columbia University Irving Medical Center
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Luis Alba
Columbia University Irving Medical Center
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Raul Silverio Francisco
Columbia University Irving Medical Center
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Celibell Vargas
Columbia University Irving Medical Center
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Angela Barrett
Columbia University Irving Medical Center
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Matthew Phillips
Merck & Co Inc
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Lyn Finelli
Merck & Co Inc
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Lisa Saiman
Columbia University Irving Medical Center
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Abstract

Background: A systematic assessment of severe clinical outcomes associated with respiratory syncytial virus (RSV) infections in adults is lacking. Methods: Within a prospective surveillance study, we performed a nested retrospective study during two respiratory viral seasons, October 2017-April 2018 and October 2018-April 2019, to determine the proportion of patients with laboratory-confirmed RSV infection who experienced severe outcomes defined as intensive care unit admission, mechanical ventilation, and/or death. We assessed factors associated with these severe outcomes. We explored the impact of RSV-associated hospitalizations on changes in the living situations of surviving patients from admission to discharge. Results: Overall, 403 patients were studied (median age 69 years); 29.5% were > 80 years. Common comorbidities included cardiac (47.6%) and pulmonary (45.9%) conditions and diabetes (41.4%). Severe outcomes occurred in 19.1% of patients including ICU admissions (16.4%), mechanical ventilation (12.4%), and/or death (6.7%). Patients admitted from residential living facilities had 4.43 times higher likelihood of severe RSV infection compared to those living in the community with or without assistance from family or home health aides. After discharge, 56 (15.1%) patients required an increased level of support including 36 (9.7%) with new admissions to residential living facilities. Conclusions: RSV infection was associated with severe illness in adults. Living in a facility was a risk factor for severe outcomes and likely a surrogate for frailty at admission rather than an independent risk factor. The need for an increased level of support after discharge will add RSV-related healthcare costs to those already incurred from hospitalization.