Acute Respiratory Failure and Ventilatory Support in Hospitalized Adults With Viral Respiratory Infection: A Retrospective Cohort Study.

BACKGROUND

This retrospective cohort study compares the risk and severity of acute respiratory failure (ARF) among adults hospitalized with different respiratory viruses.

METHODS

We included 4927 adults admitted to Akershus University Hospital, Norway, from 2012 to 2021 with polymerase chain reaction-confirmed viral infection with influenza A/B, respiratory syncytial virus (RSV), parainfluenza virus (PIV), human metapneumovirus, or severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). ARF was defined as the use of high-flow oxygen, noninvasive ventilation, or mechanical ventilation during the hospital admission. Logistic regression models estimated adjusted probabilities of respiratory failure and ventilatory support, using influenza A/B as the reference, with adjustment for age, sex, National Early Warning Score 2 (NEWS2), weighted Charlson Comorbidity Index, and other covariates.

RESULTS

Overall, 11.8% of patients (n = 583) met the criteria for ARF. Compared with influenza A/B, all other virus groups except human metapneumovirus were associated with a higher adjusted probability of ARF. SARS-CoV-2 showed the highest risk, followed by PIV and RSV (all P < .01). A similar pattern was seen for noninvasive or mechanical ventilation. Sensitivity analyses using alternative comorbidity adjustments or analyzing patients before and after the coronavirus disease 2019 pandemic separately produced consistent relative rankings across virus groups.

CONCLUSIONS

SARS-CoV-2, PIV, and RSV were associated with increased risk of ARF in hospitalized adults compared with influenza A/B. SARS-CoV-2 strains circulating during the early pandemic showed the greatest risk, while RSV and PIV also conferred a substantial excess ARF risk. These findings underscore the need for clinical vigilance and preventive strategies in patients admitted with viral respiratory tract infections.