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Meta-Analysis
. 2022 Aug 12;226(Suppl 1):S10-S16.
doi: 10.1093/infdis/jiaa751.

Risk Factors for Poor Outcome or Death in Young Children With Respiratory Syncytial Virus-Associated Acute Lower Respiratory Tract Infection: A Systematic Review and Meta-Analysis

Ting Shi  1 , Sophie Vennard  1 , Sara Mahdy  1 , Harish Nair  1 ; RESCEU investigators
Collaborators, Affiliations
Meta-Analysis

Risk Factors for Poor Outcome or Death in Young Children With Respiratory Syncytial Virus-Associated Acute Lower Respiratory Tract Infection: A Systematic Review and Meta-Analysis

Ting Shi et al. J Infect Dis. .

Abstract

Background: Respiratory syncytial virus (RSV)-associated acute lower respiratory tract infection (RSV-ALRTI) constitutes a substantial disease burden in young children. We aimed to identify all studies investigating the risk factors for RSV-ALRTI poor outcome or death in young children.

Methods: We carried out a systematic literature review across 7 databases with data from studies published from January 1995 to December 2019. We defined poor outcome as need for prolonged hospital stay, oxygen supplementation, mechanical ventilation, or intensive care unit admission. The quality of all eligible studies was assessed according to modified Grading of Recommendations, Assessment, Development and Evaluations (GRADE) criteria. We conducted meta-analyses to estimate odds ratios (ORs) with 95% confidence intervals (CIs) for individual risk factors.

Results: We identified 27 eligible studies, which investigated 20 risk factors for RSV-ALRTI poor outcome and/or death in children <5 years old, compared with children with RSV-ALRTI who did not have poor outcome or who did not die. Among the risk factors, 6 were significantly associated with RSV-ALRTI poor outcome: any comorbid condition (OR, 2.69; 95% CI, 1.89-3.83), congenital heart disease (3.40; 2.14-5.40), prematurity with gestational age (GA) <37 weeks (1.75 (1.31-2.36), prematurity with GA ≤32 weeks (2.68; 1.43-5.04), age <3 months (4.91; 1.64-14.71), and age <6 months (2.02; 1.73-2.35). The meta-estimate ORs for all risk factors other than age <3 months were based on studies using multivariable analysis. For death, only prematurity with GA <37 weeks had a significant meta-estimated OR-3.81 (95% CI, 1.68-8.63)-based on univariable analysis.

Conclusions: This study represents a comprehensive report of the association between various risk factors and RSV-ALRTI poor outcome or death in young children. More research should be carried out to elucidate risk factors associated with poor outcome or death using multivariable analysis.

Keywords: RSV; mortality; poor outcome; risk factor.

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Conflict of interest statement

Potential conflicts of interest. H. N. reports grants from the Innovative Medicines Initiative, during the conduct of the study; grants and personal fees from Sanofi Pasteur, personal fees from Janssen, personal fees from AbbVie, grants and personal fees from World Health Organization, personal fees from the Bill & Melinda Gates Foundation, and grants from the National Institute for Health Research, outside the submitted work. All other authors report no potential conflicts. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.

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