Laboratory Confirmation of Respiratory Syncytial Virus Infection Is Not Associated With an Increased Risk of Death in Adults With Acute Respiratory Illness.

Abstract

Background: Limited data have described the testing patterns and outcomes of adults (≥18 years) with acute respiratory illness (ARI) in the emergency department setting.

Methods: This prospective cohort study includes patients with ARI from a program sponsored by the Centers for Disease Control and Prevention entitled Respiratory Virus Laboratory Emergency Department Network Surveillance (RESP-LENS) from August 2021 until March 2024 (91 hospitals). Patients with ARIs were identified weekly by electronic surveillance for 1 or more of 130 ICD-10 codes that defined ARI. Patients were followed for 30 days for the primary outcomes of hospitalization and mortality. Testing for RSV with nasopharyngeal swabbing followed by reverse transcription polymerase chain reaction was done as part of usual care. Risk of 30-day mortality and RSV positivity was tested in a generalized estimating equation.

Results: From 1 210 394 patients with ARI, 345 185 (28.5%) adults underwent RSV testing, which was positive in 2.4%. In adults who were RSV+, the overall mortality rate was 1.9% as compared with 2.9% in adults who were RSV-. Mortality with RSV+ status increased with age ≥65 years to 3.8% (95% CI, 3.1%-4.5%). However, in the generalized estimating equation, RSV+ status was not associated with a higher rate of hospitalization (adjusted odds, 0.79; 95% CI, .75-.84) or 30-day mortality (odds, 0.62; 95% CI, .53-.74) relative to those who were RSV-. Age ≥65 years, incremental worsening of vital signs, male sex, and heart failure were independently associated with death.

Conclusions: Among adults with ARI presenting to an emergency department who were tested for RSV as part of their usual care, laboratory-confirmed RSV positivity was not associated with increased risk, including hospitalization, intensive care unit requirement, or death.