2016-2020年贵阳市老年呼吸道感染住院患者呼吸道合胞病毒流行特征及流感病毒感染临床严重性比较

Epidemiological characteristics and clinical severity of respiratory syncytial virus and influenza virus infections in hospitalized old patients with respiratory infection in Guiyang, 2016–2020

  • 摘要:
      目的  了解老年人呼吸道感染住院患者呼吸道合胞病毒(RSV)感染的流行病学特征,比较RSV感染与流感病毒感染的临床严重性差异,探索影响老年人呼吸道感染住院期间死亡的危险因素。
      方法  收集2016年1月1日至2020年12月31日贵阳市2家医院收治的60岁以上老年人呼吸道感染住院患者的临床和病原学检测资料。 比较RSV感染与流感病毒感染老年人在人口学特征、基础性疾病、临床表现,以及住院时间和住院期间死亡等临床结局上存在的差异,并采用多因素logistic回归模型探索影响老年人呼吸道感染住院期间死亡的危险因素。
      结果  5131例60岁以上呼吸道感染住院患者中,RSV检测阳性率为2%,流感病毒检测阳性率为10%。 77%(80/104)的RSV感染和63%(312/497)的流感病毒感染集中在每年的11月至次年2月,发病具有明显季节性。 与流感病毒感染老年人比较,RSV感染的中位发病年龄(73岁 vs. 74岁,P=0.997),ICU收治比例(7% vs. 6%,P=0.822)和住院期间死亡率(6% vs. 3%,P=0.233)差异无统计学意义。 但RSV感染的老年人中位住院天数延长(14 d vs. 12 d,P=0.041),入院时发热比例较低(50% vs. 61%,P=0.048)。 5131人中,住院期间死亡114例(2%),RSV感染死亡6例(6%),流感病毒感染死亡15例(3%),多因素logistic回归分析结果显示,在调整性别、入院前抗生素使用比例后,80岁以上高龄(aOR=3.41, 95%CI: 1.84~14.26)、具有基础性疾(aOR=2.34, 95%CI: 1.12~4.91)、发病至就诊间隔超过7 d以上(aOR=8.94, 95%CI: 1.60~29.99)、血氧饱和度低于90%(aOR=4.05, 95%CI: 1.33~12.34),以及RSV感染(aOR=5.38, 95%CI: 1.65~17.51)是老年人呼吸道感染死亡的独立危险因素。
      结论  RSV感染增加贵阳地区老年人群呼吸道感染住院期间的死亡风险,且疾病较流感更为严重。 临床大夫和公共卫生部门应给予老年人RSV感染高度关注,加强对RSV的监测、诊断和预防。

     

    Abstract:
      Objective  To describe the epidemiological characteristics of respiratory syncytial virus (RSV) infection in hospitalized old patients with respiratory tract infections, compare the differences of clinical characteristics and severity between respiratory syncytial virus (RSV) infection and influenza virus infection, and identify the risk factors of in-hospital-death of respiratory tract infection in the elderly.
      Methods  The clinical data of 5131 hospitalized patients aged ≥60 years with respiratory tract infection in two hospitals from January 1, 2016 to December 31, 2020 were collected. We compared the differences in demographics, underlying disease, clinical symptom/sign, length of hospital stay and death during hospitalization in the elderly with RSV infection and influenza virus infection, and a multivariate Logistic regression model was used to identify the risk factors of deaths in the elderly with respiratory tract infection.
      Results  Among the 5 131 hospitalized patients aged ≥60 years with respiratory tract infections, 104 were tested positive for RSV (2%) and 497 were tested positive for influenza virus (10%). During this period, 77% (80/104) of RSV infections and 63% (312/497) of influenza virus infections occurred during November - February, showing obvious seasonality. The differences in the median of age (73 years old vs. 74 years old, P=0.997), ICU admission proportion (7% vs. 6%, P=0.822) and in-hospital death rate (6% vs. 3%, P=0.233) were not significant between the old patients infected with RSV or influenza virus. Compared with the old patients infected with influenza virus, the old patients infected with RSV had longer hospitalization length median (14 d vs. 12 d, P=0.041) and lower proportion of fever at hospital admission (50% vs. 61%, P=0.048). Among the 5131 patients, 114 died during hospitalization (2%), including 6 deaths due to RDV infection (6%) and 15 deaths due to influenza virus infection (3%). The results of multivariate logistic regression analysis showed that, after adjusting for gender and antibiotic usage before admission, age ≥80 years [adjusted odds ratio (aOR)= 3.41, 95%CI: 1.84−14.26], underlying medical condition (aOR=2.34, 95%CI: 1.12−4.91), interval between illness onset and diagnosis ≥7 days (aOR=8.94, 95% CI: 1.60−29.99), blood oxygen saturation <90% (aOR=4.05, 95%CI: 1.33−12.34) and RSV infection (aOR=5.38, 95%CI: 1.65−17.51) were independent risk factors of death in the elderly with respiratory tract infection.
      Conclusion  The study highlighted that RSV as an important infection increased the risk for death in the elderly hospitalized due to respiratory infection in Guiyang. Close attention needs to be paid to RSV infection in the elderly, and RSV infection surveillance, prevention and diagnosis need to be strengthened.

     

/

返回文章
返回