2.3.2 Treatments and outcomes
Approximately 65% (390/597) of RSV infections identified in this study were inpatients. The median time from illness onset to hospital admission was 3.5 days (IQR 2–5 days) in 0–4 years old group, 3 days (IQR 1–6 days) in 5–17 years old group, 2.5 days (IQR 1–6 days) in 18–44 years old group, and 3 days (IQR 1–6 days) in ≥60 years old group with no significant difference observed. The hospitalization rates in the four age groups were different significantly as follows: 65.5%, 52.5%, 48.7%, and 78.3% (p<0.001). As age increased, the median length of hospital stay extended significantly as follows: 7 days (IQR 6–9 days), 8 days (IQR 5–11 days), 10 days (IQR 7–15 days), and 12 days (IQR 8.5–16 days) (p<0.001). The rate of ICU admission among the four age groups differed obviously as follows: 0.6%, 0.0%, 10.5%, 15.1% (p<0.001). Taken together, the patients with ≥60 years old were all the highest in the rate of hospitalization, the length of hospital stay, or the rate of ICU admission among the four age groups (Table 3).
Compared with children aged 0–4 years, the rates of antibiotic use (60.7%, 74.4%, p<0.001), oxygen support therapy (12.6%, 62.5%, p<0.001), and mechanical ventilation (8.4%, 12.5%, p=0.035) among the elderly patients aged ≥60 years were all significantly increased. However, the rates of vasoactive drug administration, corticosteroid use, and antiviral therapy among the four age groups were similar. Eight (8/597) patients with RSV infection were treated with extracorporeal membrane oxygenation (ECMO), and one case, a 63-year-old man, died (Table 3).
The most frequent complications among RSV-infected patients were acute myocardial injury in children (9% in 0–4 yr group, 6.8% in 5–17 yr group), respiratory failure in adults (11.8% in 18–59 yr group, 15.8% in ≥60 yr group). The RSV infections in adults with ≥60 years of age resulted more frequently in organ failures than in the other three younger age groups, and heart failure (13.2%) and renal failure (5.9%) were also commonly observed besides respiratory failure (15.8%). Five adults with RSV infection (0.8%, 5/597) developed acute respiratory distress syndrome (ARDS), two in the 18–59 age group and three in the ≥60 age group. (Table 3)
The median time from onset to discharge was 11 days (IQR 9–14 days) in 0–4 years old group, 13 days (IQR 10–17 days) in 5–17 years old group, 13 days (IQR 11–18 days) in 18–44 years old group, and 16 days (IQR 12–20 days) in ≥60 years old group, and extended significantly as age increased (p<0.001). The mortality of 597 RSV infections was 1.7%. No death was observed in the patients of 0–4 years and 5–17 years of age. Two deaths in the hospital occurred in the 18–49 age group (mortality 6.7%) and 8 deaths in the ≥60 age group (mortality 7.8%). From onset to death of these two age groups, the median times were 10.5 days (IQR 2–19 days) and 15.5 days (9.3–21.8 days), respectively (Table 3).