TY - JOUR
T1 - Mortality due to respiratory syncytial virus burden and risk factors
AU - Geoghegan, Sarah
AU - Erviti, Anabella
AU - Caballero, Mauricio T.
AU - Vallone, Fernando
AU - Zanone, Stella M.
AU - Losada, Juan Ves
AU - Bianchi, Alejandra
AU - Acosta, Patricio L.
AU - Talarico, Laura B.
AU - Ferretti, Adrian
AU - Grimaldi, Luciano Alva
AU - Sancilio, Andrea
AU - Dueñas, Karina
AU - Sastre, Gustavo
AU - Rodriguez, Andrea
AU - Ferrero, Fernando
AU - Barboza, Edgar
AU - Gago, Guadalupe Fernandez
AU - Nocito, Celina
AU - Flamenco, Edgardo
AU - RodriguezPerez, Alberto
AU - Rebec, Beatriz
AU - Martin Ferolla, F.
AU - Libster, Romina
AU - Karron, Ruth A.
AU - Bergel, Eduardo
AU - Polack, Fernando P.
N1 - Publisher Copyright:
© 2017 by the American Thoracic Society.
PY - 2017/1/1
Y1 - 2017/1/1
N2 - Rationale: Respiratory syncytial virus (RSV) is the most frequent cause of hospitalization and an important cause of death in infants in the developing world. The relative contribution of social, biologic, and clinical risk factors to RSV mortality in low-income regions is unclear. Objectives: To determine the burden and risk factors for mortality due to RSV in a low-income population of 84,840 infants. Methods: This was a prospective, population-based, crosssectional, multicenter study conducted between 2011 and 2013. Hospitalizations and deaths due to severe lower respiratory tract illness (LRTI) were recorded during the RSV season. All-cause hospital deaths and community deaths were monitored. Risk factors for respiratory failure (RF) and mortality due to RSV were assessed using a hierarchical, logistic regression model. Measurements and Main Results: A total of 2,588 (65.5%) infants with severe LRTI were infected with RSV. A total of 157 infants (148 postneonatal) experienced RF or died with RSV. RSV LRTI accounted for 57% fatal LRTI tested for the virus. A diagnosis of sepsis (odds ratio [OR], 17.03; 95% confidence interval [CI], 13.14-21.16 for RF) (OR, 119.39; 95% CI, 50.98-273.34 for death) and pneumothorax (OR, 17.15; 95% CI, 13.07-21.01 for RF) (OR, 65.49; 95% CI, 28.90-139.17 for death) were the main determinants of poor outcomes. Conclusions: RSV was the most frequent cause of mortality in lowincome postneonatal infants. RF and death due to RSV LRTI, almost exclusively associated with prematurity and cardiopulmonary diseases in industrialized countries, primarily affect term infants in a developing world environment. Poor outcomes at hospitals are frequent and associated with the cooccurrence of bacterial sepsis and clinically significant pneumothoraxes.
AB - Rationale: Respiratory syncytial virus (RSV) is the most frequent cause of hospitalization and an important cause of death in infants in the developing world. The relative contribution of social, biologic, and clinical risk factors to RSV mortality in low-income regions is unclear. Objectives: To determine the burden and risk factors for mortality due to RSV in a low-income population of 84,840 infants. Methods: This was a prospective, population-based, crosssectional, multicenter study conducted between 2011 and 2013. Hospitalizations and deaths due to severe lower respiratory tract illness (LRTI) were recorded during the RSV season. All-cause hospital deaths and community deaths were monitored. Risk factors for respiratory failure (RF) and mortality due to RSV were assessed using a hierarchical, logistic regression model. Measurements and Main Results: A total of 2,588 (65.5%) infants with severe LRTI were infected with RSV. A total of 157 infants (148 postneonatal) experienced RF or died with RSV. RSV LRTI accounted for 57% fatal LRTI tested for the virus. A diagnosis of sepsis (odds ratio [OR], 17.03; 95% confidence interval [CI], 13.14-21.16 for RF) (OR, 119.39; 95% CI, 50.98-273.34 for death) and pneumothorax (OR, 17.15; 95% CI, 13.07-21.01 for RF) (OR, 65.49; 95% CI, 28.90-139.17 for death) were the main determinants of poor outcomes. Conclusions: RSV was the most frequent cause of mortality in lowincome postneonatal infants. RF and death due to RSV LRTI, almost exclusively associated with prematurity and cardiopulmonary diseases in industrialized countries, primarily affect term infants in a developing world environment. Poor outcomes at hospitals are frequent and associated with the cooccurrence of bacterial sepsis and clinically significant pneumothoraxes.
KW - Bacterial superinfections
KW - Mortality
KW - Pneumothorax
KW - Respiratory syncytial virus
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U2 - 10.1164/rccm.201603-0658OC
DO - 10.1164/rccm.201603-0658OC
M3 - Article
C2 - 27331632
AN - SCOPUS:85008656528
SN - 1073-449X
VL - 195
SP - 96
EP - 103
JO - American journal of respiratory and critical care medicine
JF - American journal of respiratory and critical care medicine
IS - 1
ER -