Risk factors for mortality in geriatric hospitalized patients with respiratory syncytial virus: the FAMHous study

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The real burden of respiratory syncytial virus (RSV) in older people is probably underestimated, in spite of improvements in virological diagnosis and recent preventive and therapeutic strategies. The aim of this study is to assess in-hospital mortality risk factors in geriatric patients. This is a retrospective multicenter study. We included all patients hospitalized in geriatric wards with a positive nasopharyngeal rt-PCR for RSV during the winter seasons between November 2018 and April 2023 from three Parisian hospitals. We used a chi-square test for the ordinary variables and a Wilcoxon test for the quantitative variables to define the characteristics associated with in-hospital death. 58 patients were included, median age 89 years (72-98 years), 42 (72%) women, mean daily living activities 3.9, 10 (17%) living in nursing homes. They had several comorbidities: malnutrition (81%), neurocognitive disorder (74%), chronic heart (43%) or kidney (40%) failure. Mortality was higher in patients with dyspnea (90,0% versus 35,4% ; p = 0,003), need for oxygen supplementation (80,0% vs 35,4% ; p = 0,014), acute respiratory distress (40,0% vs 8,3% ; p = 0,024), acute heart failure (70,0% vs 27,1% ; p = 0,023), delirium (70,0% vs 22,9% ; p = 0,007), viral pneumonia (70,0% vs 39,6% ; p = 0,095), thromboembolic disease (20,0% vs 2,1% ; p = 0,074). The median hospitalization duration was 22 days (4-186 d). Although our cohort was of small size, compared with the literature, we found a higher rate of in-hospital mortality (17%) and a longer duration of hospitalization in our frail geriatric patients. The low hospitalization rate for RSV is probably explained by a lack of screening for RSV in covid epidemic. A preventive strategy against RSV seems highly relevant in this population.