Risk Factors Associated With Prolonged Hospital Length of Stay in Adult Patients With RSV
In this video, Ashish Bhargava, MD, discusses the results of his team's study on the risk factors associated with a longer hospital stay in adult patients with respiratory syncytial virus (RSV). He talks about how understanding these risk factors can help clinicians manage RSV in their patients and reduce their hospital stay during admission. Dr Bhargava presented these findings at IDWeek 2023 in Boston, Massachusetts.
Additional Resource:
Bhargava A, et al. Risk factors associated with longer hospital stay in adult patients with respiratory syncytial virus infections. Talk presented at: IDWeek 2023. October 11-15. Accessed November 22, 2023. https://idweek.org/
For more IDWeek 2023 content, visit the Resource Center.
TRANSCRIPTION:
Ashish Bhargava, MD: I'm Dr Ashish Bhargava, an infectious disease faculty at Ascension St. John Hospital. And I'm an associate professor of medicine at Wayne State University, Detroit, Michigan. Today, I will be discussing my IDWeek, presentation titled, “Risk Factors Associated With Longer Hospital Stay in Adult Patients With Respiratory Syncytial Virus Infections."
Consultant360: Please provide an overview of your session at IDWeek 2023 titled, “Risk Factors Associated with Longer Hospital Stay in Adult Patients with Respiratory Syncytial Virus Infections.”
Dr Bhargava: The respiratory syncytial virus (RSV) is known to cause severe disease in elderly individuals and patients with underlying cardiopulmonary or immunosuppressed conditions. In the United States, RSV leads to approximately 60 to 160,000 hospitalizations and about 6,000 or 10,000 deaths among adults ages 65 years or older annually. Hospital length of stay is an indirect marker for morbidity and has been directly related to the hospital cost. With increasing emphasis on high-value medical care and efforts to improve the quality of health care, length of stay is now recognized as one of the quality measures for the health care system. And little is known about the factors that are associated with prolonged length of stay for adult patients hospitalized with RSV. So we conducted a multicenter historical cohort study of patients hospitalized with RSV-related infections among Ascension hospitals in Southeast Michigan between January 2017 and December 2021, aimed to assess the risk factors associated with prolonged hospital length of stay.
In our study, we included 360 patients. They had a mean age of about 70 years. In our cohort, the mean hospital length of stay was 7 days. We had about 126 patients with prolonged hospital length of stay of greater than 7 days durations and people who had longer length of stay in hospital were found to be significantly older, were current or former smokers, had higher burden of coexisting medical conditions, required oxygen and mechanical ventilation in significantly high numbers, and experienced significant liver injuries during hospitalization compared to those who had a mean hospital length of stay of 7 days or less.
C360: How do your findings contribute to the existing literature on this topic?
Dr Bhargava: To our knowledge, this is the first study to evaluate risk factors associated with hospital length of stay among adults infected with RSV. RSV related infections among adults are an under recognized and underreported entity. RSV causes significant morbidity, especially among elderly individuals or individuals with cardiopulmonary and other immunosuppressive conditions, and it does put them at risk for hospitalization and infection-related complications. Identifying these at-risk individuals and aggressive management before and after hospitalization are crucial, not only for treating physicians, but also for hospital administrators and policymakers.
C360: Did your findings surprise you? Why or why not?
Dr Bhargava: Not having much literature about this topic, among the adult population infected with RSV, surprised us. RSV is a known cause of severe illness in young children, but it is often overlooked as a significant pathogen among older adults by many health care providers.
One of the reasons could be that in many health care settings, respiratory viral testing has been limited to influenza virus testing. So other viruses, including RSV, have not been recognized as possible etiologies for severe respiratory viral illness similar to that caused by influenza. But certainly, things have changed after the COVID-19 pandemic. There is more awareness about the viral respiratory tract infection in general, including RSV infections. And there has been a lot of, media attention, for RSV, COVID, and influenza recently. That certainly helped.
Also, after the COVID-19 pandemic, new testing modalities—particularly multiplex virus panel capable of simultaneously testing for RSV, influenza, and COVID-19,—will soon be readily available.
C360: What are the next steps in this area of research?
Dr Bhargava: Two RSV vaccines have recently received FDA approval for preventing low respiratory tract infections caused by RSV among individuals aged 60 and above. The increased use of these vaccines could potentially lead to a decrease in RSV infection-related hospitalization. Thus, continuous health surveillance efforts will be necessary to monitor the clinical trends an outcomes for RSV-related infections after the implementation of these vaccines. Also, there are new drugs in the pipeline to effectively treat RSV infection among those at risk for progression of the disease. So those will be very important and will change the dynamics for this respiratory viral infection.
C360: In your opinion, how do you hope your research impacts the future of treating patients who are hospitalized with RSV?
Dr Bhargava: Our current research work helps us to identify patients who are at higher risk for having prolonged hospital length of stay. Certainly, modifying these risk factors such as increasing vaccine coverage and improving smoking cessation counseling for these at-risk individuals could help reduce their risk for hospitalization. Early and aggressive management among at-risk patients, specifically those requiring oxygen and had liver injuries, may reduce their hospital stay during admission.
C360: What were the overall take-home messages from your presentation?
Dr Bhargava: Our study finds that age on admission, patient's smoking status, their other health conditions, liver injury during hospitalization, oxygen requirement during hospitalization, and respiratory failure requiring intubation were significantly associated with prolonged hospital length of stay among adult patients infected with RSV. Smoking cessation counseling and increasing vaccine uptake among at-risk adults can help us reduce the RSV-related hospitalizations, and early and aggressive management among at-risk patients may reduce their hospital stay during admission.
Dr Bhargava: Thank you for having me and, thank you for this invitation.