Comorbidities Drive ICU Admission and Mortality in RSV and HMPV Among Older Adults
A new retrospective cohort study from Colorado provides valuable insights into the hospital-based burden of respiratory syncytial virus (RSV) and human metapneumovirus (HMPV) in adults aged 50 and older. Drawing data from 93 hospitals within the Colorado Hospital Association database between 2016 and 2023, the analysis highlights key demographic and clinical risk factors for ICU admission and mortality, revealing notable distinctions in disease severity patterns between the two viruses.
Chronic obstructive pulmonary disease (COPD) emerged as the most significant risk factor for ICU admission in both RSV and HMPV patients. Among those hospitalized with HMPV, COPD tripled the odds of ICU admission (adjusted odds ratio [aOR], 2.99, 95% confidence interval [CI], 2.13-4.19; P < .001), while RSV patients showed a similar, though slightly lower, increase in risk (aOR, 2.24; 95% CI, 1.81-2.77; P < .001).
Neuromuscular disease without dementia was also a strong predictor of ICU utilization for both infections, with nearly identical adjusted odds ratios: 2.33 for RSV and 2.22 for HMPV (P < .001 for both).
For RSV-infected patients, age significantly increased the odds of mortality, a trend not observed with HMPV. Importantly, dementia-related neurological disorders were the most potent mortality risk factor for RSV patients (aOR, 4.16; 95% CI, 3.01-5.77; P < .001). In contrast, for HMPV, the highest mortality risk was linked to COPD, with a startling aOR of 12.44 (95% CI, 3.02-51.17; P < .001).
These findings underscore the need for clinicians to treat RSV and HMPV as clinically distinct entities when assessing patient risk and determining care pathways. “Our findings suggest that increasing age and male sex are more closely associated risks for RSV severity as determined by ICU admission and mortality outcomes, but is not necessarily the case for HMPV patients,” the study authors note.
For pharmacists, particularly those involved in inpatient care, these results reinforce the importance of detailed medication reconciliation and comorbidity review when managing older patients hospitalized with respiratory infections. Pharmacists can play a critical role in optimizing treatment for COPD, cardiovascular disease, and neurological disorders—conditions that notably elevate risk for poor outcomes.
Additionally, the striking difference in how comorbidities influence mortality and ICU admission for RSV vs HMPV suggests the need for virus-specific clinical algorithms. Pharmacists involved in protocol development or antimicrobial stewardship should consider integrating these differential risk profiles to support precise resource allocation and clinical decision-making.
Notably, the study found a clear correlation between the number of comorbidities and increased risk of both ICU admission and mortality for both viral infections. These cumulative effects highlight a key opportunity for pharmacists to advocate for holistic risk assessment strategies, especially when reviewing older adult patients with multiple chronic conditions.
The authors call for further research into longitudinal trends and clinical presentations to enrich these findings and guide the development of predictive tools. As RSV vaccines and antivirals are increasingly incorporated into care strategies, real-world evidence such as this may help refine target populations and inform preventive care approaches.
In summary, this study identifies COPD, neuromuscular disorders, and dementia as top risk factors for severe outcomes in RSV and HMPV and emphasizes the importance of tailoring care based on the unique risk profiles of each virus. Pharmacists have a critical role to play in translating these findings into improved patient outcomes.
Reference
Simões EF, Suss R, Raje D. Respiratory Syncytial Virus and Human Metapneumovirus Respiratory Hospitalizations and Outcomes in Colorado Adults ≥50 Years of Age: 2016–2023. J Infect Dis. 2025;232(Supplement_1):S19-S28. doi: 10.1093/infdis/jiaf266
