RSV Poses Significant Threat to Patients with Systemic Autoimmune Rheumatic Diseases

A Massachusetts General Hospital retrospective cohort study has found respiratory syncytial virus (RSV) infections are associated with substantial morbidity among patients with systemic autoimmune rheumatic diseases (SARDs), with more than half of infected individuals requiring hospitalization. 

Between 2015 and 2023 (prior to RSV vaccination becoming widely available), researchers identified 188 individuals with both SARDs and confirmed RSV infection. The mean patient age was 68.5 years, and 75.5 percent were female. Among these patients, 96 (51.0 percent) were hospitalized following infection. Of those hospitalized, over half (56 percent) required supplemental oxygen, and 12 deaths occurred within 90 days, representing 12.5 percent of hospitalized patients and six percent of the entire RSV-positive cohort. 

Multivariable logistic regression analysis identified several predictors of hospitalization in this cohort. A higher Charlson Comorbidity Index was associated with increased odds of hospitalization, indicating that each incremental comorbidity raised the likelihood of severe disease. Similarly, frailty was strongly associated with hospitalization risk. Individuals categorized as frail had nearly five times the odds of hospitalization compared with those who were robust or pre-frail.

Concurrent infections at the time of RSV diagnosis were another significant risk factor, associated with more than twice the odds of hospitalization. Additionally, treatment with CD20 inhibitors, such as rituximab, was linked to numerically higher hospitalization risk. Age also contributed modestly to risk, with a three percent increase in odds per additional year.

According to the researchers, the data reinforce the potential value of preventive measures, including vaccination and infection control strategies, once vaccines are accessible to this population.