Risk factors for disease severity and increased medical resource utilization in respiratory syncytial virus (+) hospitalized children: A descriptive study conducted in four Belgian hospitals

Marijke Proesmans; Annabel Rector; Els Keyaerts; Yannick Vandendijck; Francois Vermeulen; Kate Sauer; Marijke Reynders; Ann Verschelde; Wim Laffut; Kristien Garmyn; Roman Fleischhackl; Jacques Bollekens; Gabriela Ispas

doi:10.1371/journal.pone.0268532

Risk factors for disease severity and increased medical resource utilization in respiratory syncytial virus (+) hospitalized children: A descriptive study conducted in four Belgian hospitals

PLoS One. 2022 Jun 6;17(6):e0268532. doi: 10.1371/journal.pone.0268532. eCollection 2022.

Authors

Affiliations

¹ Department of Pediatrics, University Hospitals Leuven, Leuven, Belgium.
² KU Leuven Department of Microbiology, Immunology and Transplantation, Rega Institute, Laboratory of Clinical and Epidemiological Virology, Leuven, Belgium.
³ Janssen Pharmaceutica, Beerse, Belgium.
⁴ Department of Pediatrics, AZ Sint-Jan Brugge-Oostende, Campus Brugge, Brugge, Belgium.
⁵ Department of Microbiology, AZ Sint-Jan Brugge-Oostende, Campus Brugge, Brugge, Belgium.
⁶ Department of Pediatrics, AZ Sint-Jan Brugge-Oostende, Campus Henri Serruys, Oostende, Belgium.
⁷ Department of Microbiology, Heilig-Hartziekenhuis, Lier, Belgium.
⁸ Department of Pediatrics, Heilig-Hartziekenhuis, Lier, Belgium.
⁹ Janssen-Cilag Austria, Vienna, Austria.

Abstract

Background: We aimed to provide regional data on clinical symptoms, medical resource utilization (MRU), and risk factors for increased MRU in hospitalized respiratory syncytial virus (RSV)-infected Belgian pediatric population.

Methods: This prospective, multicenter study enrolled RSV (+) hospitalized children (aged ≤5y) during the 2013-2015 RSV seasons. RSV was diagnosed within 24h of hospitalization. Disease severity of RSV (+) patients was assessed until discharge or up to maximum six days using a Physical Examination Score (PES) and a derived score based on ability to feed, dyspnea and respiratory effort (PES3). MRU (concomitant medications, length of hospitalization [LOH], and oxygen supplementation) was evaluated. Kaplan-Meier survival analysis was performed to compare MRU by age and presence of risk factors for severe disease. Association between baseline covariates and MRU was analyzed using Cox regression models.

Results: In total, 75 children were included, Median (range) age was 4 (0-41) months, risk factors were present in 18.7%, and early hospitalization (≤3 days of symptom onset) was observed in 57.3% of patients. Cough (100%), feeding problems (82.2%), nasal discharge (87.8%), and rales and rhonchi (82.2%) were frequently observed. Median (range) LOH and oxygen supplementation was 5 (2-7) and 3 (1-7) days. Oxygen supplementation, bronchodilators, and antibiotics were administered to 58.7%, 64.0%, and 41.3% of the patients, respectively. Age <3 months and baseline total PES3 score were associated with probability and the duration of receiving oxygen supplementation. LOH was not associated with any covariate.

Conclusion: RSV is associated with high disease burden and MRU in hospitalized children. Oxygen supplementation but not length of hospitalization was associated with very young age and the PES3 score. These results warrant further assessment of the PES3 score as a predictor for the probability of receiving and length of oxygen supplementation in RSV hospitalized children.

Registration: NCT02133092.

Publication types

Multicenter Study
Research Support, Non-U.S. Gov't

MeSH terms

Belgium / epidemiology
Child
Child, Hospitalized
Hospitalization
Hospitals
Humans
Infant
Prospective Studies
Respiratory Syncytial Virus Infections* / diagnosis
Respiratory Syncytial Virus Infections* / epidemiology
Respiratory Syncytial Virus Infections* / therapy
Respiratory Syncytial Virus, Human*
Risk Factors
Severity of Illness Index

Associated data

ClinicalTrials.gov/NCT02133092

Grants and funding

The study was funded by Janssen Pharmaceutica NV. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.