733. Incidence and Evaluation of the Change in Functional Status Associated with Respiratory Syncytial Virus Infection in Hospitalized Older Adults
Session: Poster Abstract Session: Respiratory Infections: Viral
Thursday, October 4, 2018
Room: S Poster Hall
Posters
  • IDWeek 2018 Poster.pdf (436.6 kB)
  • Background: Respiratory Syncytial Virus (RSV) causes severe respiratory illnesses in infants and older adults. Mortality disproportionately affects the elderly, can exacerbate chronic cardiopulmonary conditions and may result in loss of function.  The purpose of this study was to determine the incidence of RSV infection in hospitalized adults and evaluate functional changes associated with RSV hospitalization in older adults ≥60 years. 

    Methods: Adults ≥18 years of age admitted with an acute respiratory infection (ARI) or exacerbation of chronic cardiopulmonary disease (e.g. CHF, COPD, asthma) preceded by an ARI within 14 days were screened. Subjects were included if hospitalized for ≥24 hours with laboratory confirmed RSV and residing in two catchment areas (Rochester, NY and New York, NY). Illness history, comorbidities and demographic characteristics were collected at enrollment.  Enrolled subjects ≥60 years underwent functional status evaluation retrospectively 2 weeks prior to hospitalization, at enrollment, discharge and 2 months using the Lawton-Brody Instrumental Activity of Daily Living (IADL) Scale (0-8), Barthel (ADL) Index (0-100), MRC Breathlessness score (1-5) and Mini-Cog instrument.

    Results: From October 2017 – March 2018, 2883 adults hospitalized with ARI were tested and 322 (11%) positive for RSV. Seventy-two adults ≥60 years underwent functional assessment. Mean age was 75 years, 53% were female and 58% demonstrated impaired cognition on admission. Five subjects died during hospitalization and one prior to 2-month follow-up. Interim analysis of 2-month functional assessment was available for 39 subjects. RSV illness resulted in acute functional loss in almost all patients.  Although there were no statistically significant differences between mean pre-hospitalization and 2-month functional scores, IADL (6.7 vs. 6.0, p=0.27), ADL (90.4 vs. 88.5, p=0.67) and MRC (2.96 vs. 2.7, p=0.57), 23% of subjects required a higher level of care at discharge. Additionally, RSV hospitalization resulted in decreased ADL scores in 36% of subjects and worsening respiratory function in 18% assessed at 2 months (Figure).

             

    Conclusion: Older adults hospitalized with RSV infection demonstrate acute functional decline which may result in prolonged loss of function in some patients.

     

    Angela Branche, MD1, Evelyn Granieri, MD, MPH2, Edward Walsh, MD, FIDSA1,3, Lynn Finelli, DrPH4, William Greendyke, MD2,5, Ann R. Falsey, MD1,3, Angela Barrett, BA6, Celibell Vargas, MD6,7 and Lisa Saiman, MD, MPH5,8, (1)Department of Medicine, Division of Infectious Diseases, University of Rochester, Rochester, NY, (2)Department of Medicine, Columbia University Medical Center, New York, NY, (3)Department of Medicine, Division of Infectious Diseases, Rochester General Hospital, Rochester, NY, (4)Center for Observational and Real-World Evidence, Merck & Co., Inc., Kenilworth, NJ, (5)Infection Prevention and Control, NewYork-Presbyterian Hospital, New York, NY, (6)Infection Prevention and Control, New York-Presbyterian Hospital, New York, NY, (7)Department of Pediatrics, Columbia University Medical Center, New York, NY, (8)Pediatrics, Columbia University Medical Center, New York, NY

    Disclosures:

    A. Branche, Merck: Investigator , Grant recipient and Research grant .

    E. Granieri, Merck: Investigator , Research grant .

    E. Walsh, Merck: Investigator , Research grant .

    L. Finelli, Merck: Employee , Salary .

    W. Greendyke, None

    A. R. Falsey, sanofi pasteur: Consultant and Grant Investigator , Consulting fee and Research grant . Gilead: Consultant , Consulting fee . Merck Sharpe and Dome: Investigator , Grant recipient . Janssen Pharmacueticals: Investigator , Grant recipient . Pfizer: Consultant , Research grant . Novavax: Consultant , none .

    A. Barrett, Merck: Investigator , Research support .

    C. Vargas, None

    L. Saiman, Merck: Investigator , Research grant .

    Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 3rd with the exception of research findings presented at the IDWeek press conferences.