Comparison of Clinical Outcomes Associated with RSV and Influenza Infections in Adults: A Multicenter Study from Türkiye (For AP-TR)

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OBJECTIVES: Respiratory syncytial virus (RSV) is an increasingly recognized cause of serious respiratory illness in adults, yet data from middle-income countries remain scarce. This study aimed to compare clinical outcomes of RSV and influenza virus infections in hospitalized and outpatient adults in Türkiye. METHODS: This retrospective multicenter study included 3,299 adult patients (≥18 years) with PCR-confirmed RSV (n=628) or influenza (n=2,671) from 21 centers across Türkiye between January 2022 and March 2024. The primary outcome was viral infection-related hospitalization. The secondary composite outcome was ICU admission and/or 30-day mortality among hospitalized patients. Propensity score-based overlap weighting was used to adjust for baseline differences including age, risk group, clinical severity, co-infection status, and study center. RESULTS: After overlap weighting, RSV infection was not significantly associated with increased hospitalization risk compared to influenza (OR: 0.96, 95% CI: 0.77-1.20, p=0.705). Similarly, no significant difference was observed in the composite outcome of ICU admission or 30-day mortality (OR: 1.40, 95% CI: 0.95-2.05, p=0.088). Age ≥60 years, high-risk comorbidities, and severe acute respiratory infection (SARI) presentation were the primary independent predictors of both hospitalization and worse outcomes. Bacterial or fungal co-infections and secondary infections were observed in 12.9% and 7.3% of hospitalized patients, respectively, with no significant difference between RSV and influenza groups. CONCLUSIONS: After adjustment for baseline characteristics, RSV and influenza were associated with comparable risks of hospitalization and severe clinical outcomes in adults. Host-related factors, particularly older age and underlying comorbidities, were the dominant determinants of adverse outcomes. These findings from a largely unvaccinated, middle-income country cohort highlight the need to expand RSV and influenza vaccination programs targeting high-risk adult populations.

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