RSV, hMPV, and PIV Linked With Severe Respiratory Disease in Hospitalized Adults

Respiratory syncytial virus (RSV), human metapneumovirus (hMPV), and parainfluenza virus (PIV) are associated with severe respiratory disease requiring augmented oxygenation or ventilation in general hospitalized patients, according to a study published in the Journal of Hospital Medicine.

“This finding is important for hospitalists because it suggests that these viruses cause significant respiratory burden in hospitalized patients and should not be discounted, even amongst those not previously thought to be at high risk of poor outcomes,” wrote first author Ajay Bhasin, MD, of the Northwestern University Feinberg School of Medicine, Chicago, Illinois, and study coauthors. 

The retrospective study included data from the National Inpatient Sample for patients aged 18 years and older who were hospitalized in the United States between 2016 and 2019. Per 100 000 people, there were an overall 23 253.0 ± 130.1 adult non-elective, nonsurgical hospitalizations. Researchers were interested in associations between RSV, hMPV, PIV, and severe respiratory disease requiring noninvasive or mechanical ventilation and death among the inpatients.

Incidence rate ratios were 1.68 for RSV, 1.82 for hMPV, and 1.81 for PIV, according to the study. Even after adjustment for other factors, each of the viruses was linked with severe respiratory disease.

“Each virus independently is at least as likely as influenza, chronic obstructive pulmonary disease, or congestive heart failure to be associated with severe respiratory disease,” the authors wrote. “Additionally, each of these viruses significantly increases the risk of severe respiratory disease in hospitalizations with patients who are pregnant.”

The study also found the viruses prolonged hospitalizations compared to hospitalizations without the viruses. In particular, RSV lengthened hospital stays by 0.79 ± 0.27 days, hMPV by 0.88 ± 0.28 days, and PIV by 1.43 ± 0.30 days.

However, the study did not find an association between the viruses and increased inpatient mortality, a finding that surprised researchers.

“In our study, these viruses are associated with severe respiratory disease, and severe respiratory disease requiring ventilation in and of itself is associated with higher mortality,” researchers wrote. “As such, these viruses reducing or lacking association with inpatient mortality is rather unlikely. It is possible there is under-testing, underdiagnosis, and underreporting of respiratory viral disease, as has been noted in multiple studies.”

Reference
Bhasin A, Nguyen DC, Briggs BJ, Nam HH. The burden of RSV, hMPV, and PIV amongst hospitalized adults in the United States from 2016 to 2019. J Hosp Med. 2024;19(7):581-588. doi:10.1002/jhm.13320