Abstract
BackgroundVarious viruses are known to be associated with pneumonia. However, the impact of viral infections on adult pneumonia mortality remains unclear. This study aimed to clarify the effect of virus infection on pneumonia mortality among adults stratified by virus type and patient comorbidities.MethodsThis multicentre prospective study enrolled pneumonia patients aged ≥15 years from September 2011 to August 2014. Sputum samples were tested by in-house multiplex polymerase chain reaction assays to identify 13 respiratory viruses. Viral infection status and its effect on in-hospital mortality were examined by age group and comorbidity status.ResultsA total of 2617 patients were enrolled in the study and 77.8% was aged ≥65 years. 574 (21.9%) did not have comorbidities, 790 (30.2%) had chronic respiratory disease, and 1253 (47.9%) had other comorbidities. Viruses were detected in 605 (23.1%) patients. Human rhinovirus (9.8%) was the most frequently identified virus, followed by influenza A (3.9%) and respiratory syncytial virus (3.9%). Respiratory syncytial virus was more frequently identified in patients with chronic respiratory disease (4.7%) than those with other comorbidities (4.2%) and without comorbidities (2.1%) (p = 0.037). The frequencies of other viruses were almost identical between the three groups. Virus detection overall was not associated with increased mortality (adjusted risk ratio (ARR) 0.76, 95% CI 0.53–1.09). However, influenza virus A and B were associated with three-fold higher mortality in patients with chronic respiratory disease but not with other comorbidities (ARR 3.38, 95% CI 1.54–7.42). Intriguingly, paramyxoviruses were associated with dramatically lower mortality in patients with other comorbidities (ARR 0.10, 95% CI 0.01–0.70) but not with chronic respiratory disease. These effects were not affected by age group.ConclusionsThe impact of virus infections on pneumonia mortality varies by virus type and comorbidity status in adults.
Highlights
Various viruses are known to be associated with pneumonia
The burden and aetiology of adult pneumonia were reported based on the data and clinical samples collected during the 1st phase of the study (September 2011 to January 2013) [9]
346 were excluded because of refusal to participate in the study (n = 48), absence of pulmonary infiltrates (n = 163), and non-pneumonia diagnosis (n = 135)
Summary
Various viruses are known to be associated with pneumonia. The impact of viral infections on adult pneumonia mortality remains unclear. This study aimed to clarify the effect of virus infection on pneumonia mortality among adults stratified by virus type and patient comorbidities. Pneumonia is the major cause of morbidity and mortality among adults, especially in the elderly. Management of pneumonia is a critical problem in an ageing society like Japan. Recent advances in molecular diagnostic techniques have enabled us to detect multiple viruses simultaneously [1]. Studies have shown that viral infection is common in pneumonia patients [2, 3]. According to a recent systematic review and meta-analysis, viruses were detected in 24.5% of respiratory samples from community-acquired pneumonia (CAP) patients [4]
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