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Clin Infect Dis
. 2025 Jul 24:ciaf405.
doi: 10.1093/cid/ciaf405. Online ahead of print. Multimorbidity Profiles and Severe In-Hospital Outcomes in Adults with Respiratory Syncytial Virus
Kevin C Ma 1 , Diya Surie 1 , Yuwei Zhu 2 , Carlos G Grijalva 2 , Paul W Blair 3 , Basmah Safdar 4 , Adit A Ginde 5 , Ithan D Peltan 6 , Samuel M Brown 6 , Manjusha Gaglani 7 , Shekhar Ghamande 8 , Cristie Columbus 9 , Nicholas M Mohr 10 , Kevin W Gibbs 11 , David N Hager 12 , Matthew E Prekker 13 , Michelle N Gong 14 , Amira Mohamed 14 , Nicholas J Johnson 15 , Jay S Steingrub 16 , Akram Khan 17 , Catherine L Hough 18 , Abhijit Duggal 19 , Alexandra June Gordon 20 , Nida Qadir 21 , Steven Y Chang 21 , Christopher Mallow 22 , Laurence W Busse 23 , Jennie H Kwon 24 , Matthew C Exline 25 , Ivana A Vaughn 26 , Mayur Ramesh 27 , Adam S Lauring 28 , Emily T Martin 29 , Aleda M Leis 29 , Jarrod M Mosier 30 , Estelle S Harris 31 , Adrienne Baughman 32 , Cassandra Johnson 2 , Jonathan D Casey 33 , Natasha Halasa 34 , James D Chappell 34 , Nathaniel Lewis 35 , Sascha Ellington 35 , Wesley H Self 36 , Fatimah S Dawood 1
Affiliations
Background: Adults hospitalized with acute respiratory infections, including respiratory syncytial virus (RSV), often have multiple underlying conditions. Few data are available on the combined effect of conditions on risk of severe outcomes from RSV disease.
Methods: We enrolled adults hospitalized with RSV at 26 hospitals in 20 US states admitted January 2022-July 2024. Seventeen underlying conditions were selected after excluding those with rare prevalence (≤1%) or high pairwise correlation (≥0.7). We applied Bayesian profile regression to identify profiles of conditions associated with increased risk of RSV severe outcomes, stratifying among adults aged 18-59 and ≥60 years.
Results: We analyzed data from 1111 adults hospitalized with RSV (median age [IQR] = 66 [53-75]). Among 397 adults aged 18-59 years, two profiles were identified: (1) minimal prevalence with fewer underlying conditions and a posterior median ICU admission risk of 21% (95% credible interval = [16‒25]); (2) cardiorenal/diabetes with frequent heart failure, chronic kidney disease, diabetes, and increased ICU admission risk (37% [27‒48]). Among 714 adults aged ≥60 years, four profiles were identified: (1) minimal prevalence (ICU admission risk = 22% [18‒26]), (2) cardiorenal/diabetes (27% [21‒34]), (3) hematologic malignancy and transplant receipt (12% [6‒21]), and (4) chronic pulmonary disease with home oxygen dependence (44% [25‒66]).
Conclusion: Distinct underlying condition profiles with varying risks of critical illness were observed among inpatients with RSV. These findings could support recognition of high-risk patients to inform RSV prevention strategies and suggest the role of multimorbidity in severe RSV disease risk warrants further attention.
Keywords: ICU admission; respiratory syncytial virus; risk factors; statistical clustering; underlying conditions.
. 2025 Jul 24:ciaf405.
doi: 10.1093/cid/ciaf405. Online ahead of print. Multimorbidity Profiles and Severe In-Hospital Outcomes in Adults with Respiratory Syncytial Virus
Kevin C Ma 1 , Diya Surie 1 , Yuwei Zhu 2 , Carlos G Grijalva 2 , Paul W Blair 3 , Basmah Safdar 4 , Adit A Ginde 5 , Ithan D Peltan 6 , Samuel M Brown 6 , Manjusha Gaglani 7 , Shekhar Ghamande 8 , Cristie Columbus 9 , Nicholas M Mohr 10 , Kevin W Gibbs 11 , David N Hager 12 , Matthew E Prekker 13 , Michelle N Gong 14 , Amira Mohamed 14 , Nicholas J Johnson 15 , Jay S Steingrub 16 , Akram Khan 17 , Catherine L Hough 18 , Abhijit Duggal 19 , Alexandra June Gordon 20 , Nida Qadir 21 , Steven Y Chang 21 , Christopher Mallow 22 , Laurence W Busse 23 , Jennie H Kwon 24 , Matthew C Exline 25 , Ivana A Vaughn 26 , Mayur Ramesh 27 , Adam S Lauring 28 , Emily T Martin 29 , Aleda M Leis 29 , Jarrod M Mosier 30 , Estelle S Harris 31 , Adrienne Baughman 32 , Cassandra Johnson 2 , Jonathan D Casey 33 , Natasha Halasa 34 , James D Chappell 34 , Nathaniel Lewis 35 , Sascha Ellington 35 , Wesley H Self 36 , Fatimah S Dawood 1
Affiliations
- PMID: 40708527
- DOI: 10.1093/cid/ciaf405
Background: Adults hospitalized with acute respiratory infections, including respiratory syncytial virus (RSV), often have multiple underlying conditions. Few data are available on the combined effect of conditions on risk of severe outcomes from RSV disease.
Methods: We enrolled adults hospitalized with RSV at 26 hospitals in 20 US states admitted January 2022-July 2024. Seventeen underlying conditions were selected after excluding those with rare prevalence (≤1%) or high pairwise correlation (≥0.7). We applied Bayesian profile regression to identify profiles of conditions associated with increased risk of RSV severe outcomes, stratifying among adults aged 18-59 and ≥60 years.
Results: We analyzed data from 1111 adults hospitalized with RSV (median age [IQR] = 66 [53-75]). Among 397 adults aged 18-59 years, two profiles were identified: (1) minimal prevalence with fewer underlying conditions and a posterior median ICU admission risk of 21% (95% credible interval = [16‒25]); (2) cardiorenal/diabetes with frequent heart failure, chronic kidney disease, diabetes, and increased ICU admission risk (37% [27‒48]). Among 714 adults aged ≥60 years, four profiles were identified: (1) minimal prevalence (ICU admission risk = 22% [18‒26]), (2) cardiorenal/diabetes (27% [21‒34]), (3) hematologic malignancy and transplant receipt (12% [6‒21]), and (4) chronic pulmonary disease with home oxygen dependence (44% [25‒66]).
Conclusion: Distinct underlying condition profiles with varying risks of critical illness were observed among inpatients with RSV. These findings could support recognition of high-risk patients to inform RSV prevention strategies and suggest the role of multimorbidity in severe RSV disease risk warrants further attention.
Keywords: ICU admission; respiratory syncytial virus; risk factors; statistical clustering; underlying conditions.