In-hospital and midterm post-discharge complications of adults hospitalised with respiratory syncytial virus infection in France, 2017-2019: an observational study.

Objectives: The purpose of this study was to describe the clinical characteristics and in-hospital and post-discharge outcomes of respiratory syncytial virus (RSV) infection among adults hospitalised with influenza-like illness (ILI) and compared against patients admitted for influenza.
Methods: Adults hospitalised with ILI were prospectively included from five French university hospitals over two consecutive winter seasons (2017/2018 and 2018/2019). RSV and influenza virus were detected by multiplex reverse transcription PCR on nasopharyngeal swabs. RSV-positive patients were compared to RSV-negative and influenza-positive hospitalised patients. Poisson regression models were used to estimate the adjusted prevalence ratio (aPR) associated with in-hospital and post-discharge outcomes between RSV and influenza infections. The in-hospital outcome was a composite of the occurrence of at least one complication, length of stay ≥7 days, intensive care unit admission, use of mechanical ventilation and in-hospital death. Post-discharge outcome included 30- and 90-day all-cause mortality and 90-day readmission rates.
Results: Overall, 1428 hospitalised adults with ILI were included. RSV was detected in 8% (114 of 1428) and influenza virus in 31% (437 of 1428). Patients hospitalised with RSV were older than those with influenza (mean age 73.0 versus 68.8 years, p=0.015) with a higher frequency of chronic respiratory or cardiac disease (52% versus 39%, p=0.012, and 52% versus 41%, p=0.039, respectively) and longer hospitalisation duration (median stay 8 versus 6 days, p<0.001). Anti-influenza therapies were less prescribed among RSV patients than influenza patients (20% versus 66%, p<0.001). In-hospital composite outcome was poorer in RSV patients (aPR 1.5, 95% CI 1.1-2.1) than in those hospitalised with influenza. No difference was observed for the post-discharge composite outcome (aPR 1.1, 95% CI 0.8-1.6).
Conclusion: RSV infection results in serious respiratory illness, with worse in-hospital outcomes than influenza and with similar midterm post-discharge outcomes.
Competing Interests: Conflict of interest: N. Lenzi has nothing to disclose. Conflict of interest: F. Galtier has nothing to disclose. Conflict of interest: F. Lainé has nothing to disclose. Conflict of interest: Z. Lesieur has nothing to disclose. Conflict of interest: P. Vanhems reports grants from Pfizer, Sanofi, Anios, MSD and Astellas, outside the submitted work. Conflict of interest: S. Amour has nothing to disclose. Conflict of interest: A-S. L'Honneur has nothing to disclose. Conflict of interest: N. Fidouh has nothing to disclose. Conflict of interest: V. Foulongne has nothing to disclose. Conflict of interest: G. Lagathu has nothing to disclose. Conflict of interest: X. Duval has nothing to disclose. Conflict of interest: C. Merle has nothing to disclose. Conflict of interest: B. Lina has nothing to disclose. Conflict of interest: F. Carrat has nothing to disclose. Conflict of interest: O. Launay is principal investigator for clinical trials sponsored by Janssen, GSK, Pfizer, Sanofi Pasteur and MSD, outside the submitted work. Conflict of interest: P. Loubet reports personal fees from Pfizer and non-financial support from Sanofi Pasteur, outside the submitted work. Conflict of interest: A. Descamps has nothing to disclose.
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