Understanding risk of poor outcomes in adults hospitalised with respiratory syncytial virus infection: evidence from a multicentre UK cohort

TY - JOUR

T1 - Understanding risk of poor outcomes in adults hospitalised with respiratory syncytial virus infection

T2 - evidence from a multicentre UK cohort

AU - Morelli, Tommaso

AU - Purcell, Martha

AU - Panaguiton, Jon

AU - Patel, Rachel

AU - Weinberg, Sharon

AU - Hulston, George

AU - Siy-Yap, Hans

AU - Davies, Emma A.

AU - Keating, Anluan

AU - Saidy, Ida

AU - Freeman, Anna

AU - Staples, Karl J.

AU - Rodrigues, Pedro

AU - Jones, Abigail

AU - Allen, Alexander

AU - Bansal, Aruna T.

AU - Marciniak, Stefan J.

AU - Greening, Neil J.

AU - Crooks, Michael G.

AU - Mitchelmore, Philip

AU - Siddiqui, Salman H.

AU - Myerson, James

AU - Pavitt, Matthew J.

AU - Daneshvar, Cyrus

AU - Chalmers, James D.

AU - Lee, Paul H.

AU - Lewis, Tom

AU - Clark, Tristan W.

AU - Denny, Sarah

AU - Wiseman, Dexter J.

AU - Ellis, Huw

AU - Wilkinson, Tom M.A.

N1 - Copyright: © Author(s) (or their employer(s)) 2026.

PY - 2026/2/5

Y1 - 2026/2/5

N2 - Background: Respiratory syncytial virus (RSV) causes substantial winter pressure on adult services. In the UK, RSV vaccination currently targets adults aged ≥75 years and care home residents; it remains uncertain whether this age criterion alone meaningfully discriminates risk of poor outcome among adults hospitalised with RSV.Methods: We pooled three UK hospital cohorts (one prospective, two retrospective) of adults admitted with acute respiratory infection (ARI) and PCR-confirmed RSV. The primary outcome was intensive care unit/ high dependency unit (ICU/HDU) admission or all-cause mortality within 60 days. Prespecified predictors (age, sex and comorbidities) entered a least absolute shrinkage and selection operator (LASSO) penalised logistic regression; selected variables were refitted using standard logistic regression. Discrimination, calibration and decision-analytic performance were assessed using 1000-bootstrap internal validation and decision-curve analysis.Results: Among 334 adults, 37 (11.1%) experienced the primary outcome. An age-only rule mirroring current UK vaccine age-eligibility (≥75 years) demonstrated only modest discrimination (optimism-adjusted area under the receiver operating characteristic curve (AUC) 0.58, 95% CI 0.48 to 0.65) and a compressed distribution of predicted risks. A four-predictor model—including age, COPD, active/previous cancer and dementia—achieved higher discrimination AUC (0.77 (0.69 to 0.85)), a wider spread of predicted risks and the greatest net benefit across clinically plausible escalation thresholds (5–20%).Conclusions: In adults hospitalised with RSV-associated ARI, simple age-based heuristics—including the UK ≥75-year threshold—showed only modest ability to discriminate risk of ICU/HDU admission/60-day mortality once hospitalised. Comorbidity-inclusive approaches may provide more informative hospital-level risk stratification and warrant evaluation in future RSV vaccine-effectiveness and outcome studies. Any application requires external validation, more systematic RSV testing and comparison with physiology-based scores in larger, vaccinated cohorts.

AB - Background: Respiratory syncytial virus (RSV) causes substantial winter pressure on adult services. In the UK, RSV vaccination currently targets adults aged ≥75 years and care home residents; it remains uncertain whether this age criterion alone meaningfully discriminates risk of poor outcome among adults hospitalised with RSV.Methods: We pooled three UK hospital cohorts (one prospective, two retrospective) of adults admitted with acute respiratory infection (ARI) and PCR-confirmed RSV. The primary outcome was intensive care unit/ high dependency unit (ICU/HDU) admission or all-cause mortality within 60 days. Prespecified predictors (age, sex and comorbidities) entered a least absolute shrinkage and selection operator (LASSO) penalised logistic regression; selected variables were refitted using standard logistic regression. Discrimination, calibration and decision-analytic performance were assessed using 1000-bootstrap internal validation and decision-curve analysis.Results: Among 334 adults, 37 (11.1%) experienced the primary outcome. An age-only rule mirroring current UK vaccine age-eligibility (≥75 years) demonstrated only modest discrimination (optimism-adjusted area under the receiver operating characteristic curve (AUC) 0.58, 95% CI 0.48 to 0.65) and a compressed distribution of predicted risks. A four-predictor model—including age, COPD, active/previous cancer and dementia—achieved higher discrimination AUC (0.77 (0.69 to 0.85)), a wider spread of predicted risks and the greatest net benefit across clinically plausible escalation thresholds (5–20%).Conclusions: In adults hospitalised with RSV-associated ARI, simple age-based heuristics—including the UK ≥75-year threshold—showed only modest ability to discriminate risk of ICU/HDU admission/60-day mortality once hospitalised. Comorbidity-inclusive approaches may provide more informative hospital-level risk stratification and warrant evaluation in future RSV vaccine-effectiveness and outcome studies. Any application requires external validation, more systematic RSV testing and comparison with physiology-based scores in larger, vaccinated cohorts.

UR - https://www.scopus.com/pages/publications/105030192630

U2 - 10.1136/thorax-2025-224192

DO - 10.1136/thorax-2025-224192

M3 - Article

C2 - 41644135

AN - SCOPUS:105030192630

SN - 0040-6376

JO - Thorax

JF - Thorax

M1 - 224192

ER -