Clinical phenotypes and outcomes of SARS-CoV-2, influenza, RSV and seven other respiratory viruses: a retrospective study using complete hospital data

Abstract

BackgroundAn understanding of differences in clinical phenotypes and outcomes COVID-19 compared with other respiratory viral infections is important to optimise the management of patients and plan healthcare. Herein we sought to investigate such differences in patients positive for SARS-CoV-2 compared with influenza, respiratory syncytial virus (RSV) and other respiratory viruses.MethodsWe performed a retrospective cohort study of hospitalised adults and children (≤15 years) who tested positive for SARS-CoV-2, influenza virus A/B, RSV, rhinovirus, enterovirus, parainfluenza viruses, metapneumovirus, seasonal coronaviruses, adenovirus or bocavirus in a respiratory sample at admission between 2011 and 2020.ResultsA total of 6321 adult (1721 SARS-CoV-2) and 6379 paediatric (101 SARS-CoV-2) healthcare episodes were included in the study. In adults, SARS-CoV-2 positivity was independently associated with younger age, male sex, overweight/obesity, diabetes and hypertension, tachypnoea as well as better haemodynamic measurements, white cell count, platelet count and creatinine values. Furthermore, SARS-CoV-2 was associated with higher 30-day mortality as compared with influenza (adjusted HR (aHR) 4.43, 95% CI 3.51 to 5.59), RSV (aHR 3.81, 95% CI 2.72 to 5.34) and other respiratory viruses (aHR 3.46, 95% CI 2.61 to 4.60), as well as higher 90-day mortality, ICU admission, ICU mortality and pulmonary embolism in adults. In children, patients with SARS-CoV-2 were older and had lower prevalence of chronic cardiac and respiratory diseases compared with other viruses.ConclusionsSARS-CoV-2 is associated with more severe outcomes compared with other respiratory viruses, and although associated with specific patient and clinical characteristics at admission, a substantial overlap precludes discrimination based on these characteristics.

Predictors of all-cause mortality among patients hospitalized with influenza, respiratory syncytial virus, or SARS-CoV-2

“…Our results add to the growing literature base comparing similarities and differences in clinical disease progression of patients hospitalized with influenza and SARS-CoV-2 [42][43][44],…”

“…Our results add to the growing literature base comparing similarities and differences in clinical disease progression of patients hospitalized with influenza and SARS-CoV-2 [42–44], and have three important implications for clinical care and health systems. First, shared predictors of mortality could be used to identify, target, and prioritize hospitalized patients who are at greatest risk of death for prevention (e.g.…”

“…These comorbidities may have been associated with mortality among influenza and RSV patients, but not SARS-CoV-2 patients due to: 1) smaller sample size of the latter; 2) greater hospitalization rates of less severe patients with comorbidities who were infected with SARS-CoV-2 (i.e. selective hospitalization of patients with comorbidities due to limited understanding of the virus and disease trajectory); and/or 3) true clinical differences between patients requiring hospitalization with SARS-CoV-2 versus seasonal influenza or RSV [42][43][44]. Moreover, age may act as an effect measure modifier on the relationship between comorbidities and mortality due to SARS-CoV-2.…”

“…selective hospitalization of patients with comorbidities due to limited understanding of the virus and disease trajectory); and/or 3) true clinical differences between patients requiring hospitalization with SARS-CoV-2 versus seasonal influenza or RSV. [41][42][43] Moreover, age may act as an effect measure modifier on the relationship between comorbidities and mortality due to SARS-CoV-2. More research is needed to compare the immunological and clinical disease progression of influenza, RSV, and SARS-CoV-2 to better explain observed differences in risk by comorbidity.…”

Outbreak of Influenza and Other Respiratory Viruses in Hospitalized Patients Alongside the SARS-CoV-2 Pandemic

“…COVID-19 has similar symptoms resembling influenza, including fever, headache, muscle ache and symptoms in the upper respiratory system such as coughing. Studies have shown that mortality rates in case of COVID-19 infection with the wild type SARS-CoV-2 may be even higher than infection with winter respiratory viruses ( WHO, 2021 ; Hedberg et al, 2022 ). Overall, respiratory infection caused by either influenza, other respiratory viruses or COVID-19 can lead to serious complications such as cardiovascular events and bacterial co-infections that may be lethal ( Piroth et al, 2021 ; Hedberg et al, 2022 ).…”