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Abstract

Introduction: Human rhinoviruses (HRVs) cause nearly half of all acute respiratory illness, which tend to be mild in nature. Recent evidence suggests that HRVs may be an important cause of lower respiratory tract infection. The recent availability of respiratory viral polymerase chain reaction testing has improved our ability to identify and survey infectious agents like HRVs. We investigated the impact of HRVs on morbidity and mortality outcomes in children with severe viral respiratory infection. Methods: This was a retrospective cohort study of all patients admitted to the intensive care unit (ICU) at three urban academic tertiary care children's hospitals with laboratory-confirmed HRV respiratory infection between January 2010 and June 2011. We captured demographic and clinical data and analyzed associated morbidity and mortality outcomes. Results: There were 519 patients included in our analysis. The median patient age was 2.7 years. The median hospital and ICU lengths of stay were 4 days and 2 days, respectively. 34% of patients had a history of asthma and 26% of patients had a chronic medical condition other than asthma. 32% of patients required mechanical ventilation. Twelve patients (2.3%) did not survive to discharge. The rate of viral co-infection was low (12.5%) and was not associated with mortality. Predisposing factors associated with increased mortality included immunocompromised state (p<0.001), neuromuscular disease (p=0.013), severity of illness score (p<0.001) and bacterial co-infection (p=0.005). Controlling for bacterial co-infection and severity of illness, immunocompromised state and neuromuscular disease each independently increased mortality [OR=22, p<0.001 and OR=15, p=0.002, respectively]. Conclusions: Analysis of our results suggests that there is substantial morbidity and mortality associated with severe respiratory infection due to HRVs in children. Immunocompromised state and neuromuscular disease independently increase mortality. The burden of illness from HRVs on the ICU in terms of resource utilization may be considerable.