Understanding risk of poor outcomes in adults hospitalised with respiratory syncytial virus infection: evidence from a multicentre UK cohort
Year: 2026
Type: article
Abstract: 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.
Source: Thorax
Authors: Tommaso Morelli, Martha Purcell, Jon Panaguiton, Rachel Patel, Sharon Weinberg, George Hulston, Hans Siy-Yap, Emma A Davies, Anluan Keating, Ida Saidy, Anna Freeman, Karl J Staples, Pedro Rodrigues, Abigail Jones, Alexander Allen, Aruna T Bansal, Stefan J Marciniak, Neil J Greening, Michael G Crooks, Philip Mitchelmore, Salman H Siddiqui, James Myerson, Matthew J Pavitt, Cyrus Daneshvar, James D Chalmers, Paul H Lee, Tom Lewis, Tristan W Clark, Sarah Denny, Dexter J Wiseman, Huw Ellis, Tom MA Wilkinson
Institutions: University Hospital Southampton NHS Foundation Trust, NIHR Southampton Biomedical Research Centre, University of Southampton, St Thomas' Hospital, Guy's and St Thomas' NHS Foundation Trust, Royal Devon University Healthcare NHS Foundation Trust, Manchester University NHS Foundation Trust, Royal Papworth Hospital, Cambridge University Hospitals NHS Foundation Trust, University of Leicester, Hull York Medical School, Imperial College London, University Hospitals Sussex NHS Foundation Trust, University Hospitals Plymouth NHS Trust, University of Dundee, Ninewells Hospital, Chelsea and Westminster Hospital NHS Foundation Trust
Language: English
Subfield: Epidemiology
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
OpenAlex ID: W7127953795