Influenza, RSV, and COVID-19: Identifying determinants of hospitalization influence

Influenza, RSV, and COVID-19: Identifying determinants of hospitalization influence | Image Credit: © angellodeco - © angellodeco- stock.adobe.com.

Investigators of a study recently published in the Journal of Clinical Medicine sought to examine clinical characteristics of respiratory viral infections, including COVID-19, influenza, and respiratory syncytial virus (RSV) while identifying determinants influencing the likelihood of hospitalization.

Determining age-associated discrepancies from comparative research across infections could help facilitate the "prompt identification of patients necessitating medical intervention, thereby enhancing our comprehension of these infections and optimizing patient care strategies," the study authors wrote.

The investigators retrospectively analyzed electronic medical records (EMRs) of patients that had been discharged from the emergency department with a diagnosis of either COVID-19, seasonal influenza, or RSV, from January 1, 2015 to December 31, 2022, with the study conducted at a tertiary hospital in Gyeonggi Province, South Korea.

Patients with these diagnoses were included and divided into a group of pediatric patients under age 18 years, or adults aged 18 years or older.

The pediatric group was further classified into groups of neonate (0 months), infant (1–11 months), toddler (1–2 years), preschooler (3–5 years), school age (6–12 years), and adolescent (13–17 years).

In the study period, there were a total of 12,000 patients diagnosed with either COVID-19, influenza, or RSV. A total of 252 pediatric patients (under age 18 years) were diagnosed with COVID-19, 6055 children had influenza, and 956 children were diagnosed with RSV.

Among the respiratory viral infections (RVI) groups, COVID-19 had the highest average age at 49.2 ± 27.7 years. Influenza was 19.5 ± 23.0 years, and RSV at 0.6 ± 2.8 years, indicating the youngest average age in RSV patients.

For COVID-19, data highlighted a higher number of boys in the pediatric group, where the average age was 3.7 ± 5.1 years. Infants aged 1 to 11 months were most common in the pediatric group.

Boys were again more common among the pediatric influenza group, with the most common age being between 3 and 5 years. Compared to adults, pediatric patients with influenza infection had a higher rate of chest x-ray abnormalities, at 21.5%.

Children made up all but 1 RSV diagnosis in the study. As in the other groups, the majority (55.5%) in the pediatric group were boys. In all, 57.8% of the pediatric group with RSV were infants. Six hundred patients (82.8%) were hospitalized. According to the study authors, all imaging studies conducted revealed abnormal findings.

Odds ratios were calculated using univariate analysis with age and disease as variables to identify factors affecting hospital admissions. In the pediatric group, neonates had the highest admission risk of 80.0 times, infants at 8.9 times, and toddlers at 2.2 times.

Compared to influenza, pediatric admissions for COVID-19 were 9.7 times higher and 8.0 times higher for RSV, respectively.

Overall, the study revealed that, in the case of children, the risk of hospitalization increased with younger age, and that COVID-19 infection and RSV infection were analyzed as factors "influencing hospitalization, compared to seasonal influenza."

The investigators concluded that age-related risk differences "highlight the necessity for tailored strategies, improving understanding of and treatment development for RVIs."

Reference:

Kwon J-H, Paek S-H, Park S-H, Kim M-J, Byun Y-H, Song H-Y. COVID-19, Influenza, and RSV in Children and Adults: A Clinical Comparative Study of 12,000 Cases. Journal of Clinical Medicine. 2024; 13(6):1702. https://doi.org/10.3390/jcm13061702