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Clinical features and survival analysis of adult patients with severe lower respiratory tract infection positive for respiratory syncytial virus

BMC Pulmonary Medicine volume 25, Article number: 184 (2025) Cite this article

Abstract

Background

The awareness and attention toward lower respiratory tract infections caused by respiratory syncytial virus (RSV) are lower in adults than in children. Moreover, the clinical data on severe RSV infections in adults are lacking. This study aimed to augment the clinical understanding of RSV infections.

Method

This study was performed on 191 adult patients with severe lower respiratory tract infections admitted to the intensive care unit (ICU) of Zunyi Medical University Affiliated Hospital (Zhuhai). The sputum specimens were collected for RSV testing, and the clinical data were collected and analyzed statistically.

Results

The findings revealed that patients in the RSV-positive group were older, had a higher prevalence of underlying diseases, were more likely to require noninvasive mechanical ventilation, and had prolonged hospital stays compared with those in the RSV-negative group. Furthermore, Kaplan–Meier survival analysis conducted within 90 days revealed comparable mortality rates between the RSV-positive and RSV-negative groups. In the RSV-positive group, elderly patients and patients with congestive heart failure or chronic obstructive pulmonary disease had lower survival rates.

Conclusion

Patients in the RSV-positive group, particularly elderly patients and patients with congestive heart failure or, experience reduced survival durations compared with those in the RSV-negative group.

Peer Review reports

Introduction

Respiratory syncytial virus (RSV) is widely recognized as a prevalent cause of severe respiratory illness, especially in infants [1]. However, it has increasingly been identified as a significant threat to adult health in recent years. The clinical manifestations of RSV infection vary, ranging from mild flu-like symptoms to severe respiratory complications [2]. In the United States, RSV infections are estimated to cause approximately 177,000 hospitalizations and 10,000–14,000 deaths, with healthcare costs exceeding $100 million annually, particularly among individuals aged ≥ 65 years [3]. Despite these alarming figures, the awareness in society and the clinical recognition of RSV infection as a major contributor to severe respiratory diseases in the adult population is lacking.

RSV infection increases the risk of acute exacerbations, hospitalization rates, and 60-day mortality in patients with chronic respiratory diseases, including chronic obstructive pulmonary disease (COPD), asthma, bronchiectasis, and interstitial lung disease. Further, impaired immune defenses enhance susceptibility to RSV infection in immunocompromised populations such as lung transplant recipients, patients with cancer, and patients undergoing immunosuppressive therapy [4–5]. RSV infection is often characterized by prolonged or recurrent episodes in children, which may precipitate airway diseases such as asthma or COPD [6]. It constitutes a significant risk factor for cardiovascular diseases. Approximately 14–22% of adult patients hospitalized for respiratory illnesses due to RSV infection concurrently experience cardiovascular events, including exacerbations of congestive heart failure (CHF), acute coronary syndrome, and arrhythmias. Further, 45–63% of adult patients diagnosed with RSV infection admitted to hospitals are at risk of potential cardiovascular diseases [7]. Recent studies have reported an annual incidence rate of 2–10% for RSV-related cardiorespiratory diseases in adults during the winter season. A subset of patients with acute exacerbation of these diseases may require admission to the intensive care unit (ICU) for therapeutic interventions [8]. Furthermore, among adults hospitalized due to RSV lower respiratory tract infections (LRTIs), approximately 10–31% need ICU admission and 3–17% require mechanical ventilation. The overall mortality rate associated with these conditions may reach as high as 6–8% [9]. These data underscore the increasing severity of LRTIs attributable to RSV. However, a significant gap remains in clinical understanding regarding the socioeconomic impacts of severe LRTIs caused by RSV in the adult population.

Hence, a meticulous analysis of the clinical features of severe RSV infections is pertinent for their early identification and prompt management. This can help mitigate the heavy burden and adverse prognosis associated with the condition. A total of 191 sputum specimens were obtained from adult patients with severe LRTIs hospitalized in the ICU during the observational period from July 2022 to July 2023. These specimens were rigorously tested for the presence of RSV using nucleic acid analysis. The patients were stratified into two cohorts: RSV-positive and RSV-negative. A comprehensive dataset encompassing clinical parameters was systematically subjected to in-depth comparative analyses. This methodological approach aimed at augmenting the clinical understanding of RSV infections. This study further intended to provide essential theoretical underpinnings and practical implications for the early identification and prompt management of RSV infections in clinical practice.

Materials and methods

Study design and participants

Adult patients hospitalized for severe LRTIs due to RSV at Zhuhai Hospital, Zunyi Medical University during July 2022–2023 were enrolled in this study. All patients underwent RSV nucleic acid testing and were categorized into RSV infection-positive and RSV infection-negative groups based on the test results. As shown in Fig. 1, the inclusion criteria were as follows: (1) Age ≥ 18 years; (2) Meeting the European diagnostic criteria for LRTIs [10]. (3) Fulfilling the ATS/IDSA criteria for severe community-acquired pneumonia [11]. The exclusion criteria we data, follows: (1) Age < 18 years; (2) upper respiratory tract infection; (3) diagnosis of LRTI after 48 h of admission; (4) patients undergoing long-term chemotherapy, steroid use, and those with incomplete clinical data; (5) those who were unable to cooperate owing to neurological or psychiatric disorders; (6) those with non-severe LRTI; (7) those unwilling to participate in the study. Before the commencement of the study, written informed consent was obtained from all adult inpatients (≥ 18 years). The study was approved by the Ethics Committee of Zhuhai Hospital, Zunyi Medical University (Approval No: 2023ZH0035, dated January 2023), and was conducted in accordance with the principles of the Helsinki Declaration, 1964.

A total of 234 participants agreed to participate in this study, and 191 participants were recruited according to the inclusion and exclusion criteria. We conducted sputum collection and nucleic acid testing on the participants, yielding results that indicated 63 individuals in the RSV-positive group and 128 individuals in the RSV-negative group. Following this, clinical information was gathered, and a statistical analysis was performed (Fig. 1).

Fig. 1
figure 1

Flow chart of the experiment

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Sputum collection and testing procedure

In the early morning of the second day after the patient’s admission to the ICU, the attending nurse communicated the purpose and utility of specimen collection. The bedside nurse cross-verified patient information, activated the suction device, adjusted the negative pressure, and opened the sputum collection kit. An appropriate amount of saline was poured into the collection bowl, followed by hand disinfection and the donning of isolation garments and gloves. The following procedures were then performed based on the intubation status of the patient: (1) For intubated patients, after the patient inhaled pure oxygen for 2 min, the disposable sputum cup was connected to the suction catheter. The ventilator was disconnected from the endotracheal tube, an appropriate amount of saline was aspirated to check for patency, and the suction catheter was quickly inserted vertically into the endotracheal tube to an appropriate depth while simultaneously rotating and withdrawing the catheter. The suction time did not exceed 15 s. After suction, the ventilator was reconnected, and the suction device was closed. (2) For non-intubated patients, the suction catheter was gently inserted into the mouth (or nose) to the pharynx and the catheter end was relaxed to cleanse the secretions from the pharynx. Subsequently, the suction catheter was replaced and inserted deeply into the pharynx to enter the trachea for suction. Following the suction procedure, the patient’s hospital identification number and name were promptly documented. The sputum collection cup was subsequently placed in a low-temperature storage container and immediately transported to the laboratory for RSV testing.

RNA extraction and RSV detection

The obtained sputum samples were mixed with an equal volume of 0.1% dithiothreitol solution, with vortexing and shaking, and incubated at 37℃ for 30 min to complete liquefication. Then, 1 mL of liquefied sputum was centrifuged at 12,000g at 4℃ for 10 min, and the supernatant was collected for RNA extraction. Sputum RNA was extracted using an RNA-easy Isolation Reagent following the manufacturer’s protocols. Finally, RSV was detected by quantitative polymerase chain reaction (qPCR). RSV was positive when the Ct value of the FAM channel was ≤ 35 and the amplification curve was “S” type. A disposable sputum collection cup and a suction catheter were procured from Jiangsu Kangjian Medical Supplies Co., Ltd. An RNA-easy Isolation Reagent kit was obtained from Guizhou Keaode Biotechnology Co., Ltd. Dithiothreitol was procured from Beijing Solarbio Technology Co., Ltd. A qPCR instrument was obtained from Bio-Rad (USA). All procedures were conducted in accordance with the manufacturer’s instructions.

Data collection

Patients’ medical records were retrospectively reviewed to compile the following comprehensive dataset: hospital identification number, patient’s name, admission date, address, contact number, age, Gender, underlying disease, body mass index, detailed clinical symptoms (including myalgia, headache, fever, chest tightness, shortness of breath, heart rate, wet rales, and wheezing sound), results from extensive Laboratory examination (encompassing Blood counts and ratios, platelet count, neutrophil lymphocyte ratio (NLR), liver and kidney function tests, cardiac enzymes, coagulation profile, brain natriuretic peptide (BNP), blood gas analysis, PaO2 to FIO2 ratio, and procalcitonin), assessments of disease severity (including APACHE II score, SOFA score, and SIRS score), sputum bacterial cultures, chest CT findings, documented complications, instances of mechanical ventilation, the use of vasoactive drugs, hospitalization duration, hospital mortality rates, and conclusive discharge diagnosis.

Statistical analysis

Data were analyzed using SPSS 29.0 statistical software. Non-normally distributed quantitative data were expressed as median and interquartile range (IQR), and the Mann–Whitney U test was used for group comparisons. Normally distributed metric data were expressed as (x ± s), and t-tests were applied for comparisons. Furthermore, count data were presented as [cases (%)] and compared using the χ2 test. Variables exhibiting statistically significant differences were subjected to logistic regression analysis, and the Kaplan-Meier method was employed to evaluate the impact of relevant factors on survival time. A significance level of *P < 0.05 was considered statistically significant.

Results

Distribution of onset time in patients with severe LRTI in the RSV-positive and RSV-negative groups

Continuous 1-year monitoring revealed a larger number of patients with severe LRTI in the RSV-negative group than in those in the RSV-positive group. The peak incidence of patients with severe LRTI in the RSV-positive group occurred from January to February and from November to December each year. The highest incidence was noted in winter, accounting for 70% of the patients in the RSV-positive group. In contrast, an apparent seasonal trend was not observed in the RSV-negative group (Fig. 2A and B).

Fig. 2
figure 2

(A) Bar chart of time distribution of severe lower respiratory tract infection (LRTI) between RSV-positive and RSV-negative groups. (B) Stacked bar graph of time distribution of severe LRTI between RSV-positive and RSV-negative groups

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Baseline characteristics of patients with severe LRTI: RSV-positive versus RSV-negative groups

This retrospective analysis the baseline features of 63 patients with severe LRTI in the RSV-positive group and compared them with 128 patients in the RSV-negative group. The RSV-positive group with an average age of 73 years displayed a statistically significant difference compared with the RSV-negative group with an average age of 69 years (*P < 0.05). The sex distribution in the RSV-positive group revealed 45 men and 18 women, with an average age of 71.91 ± 10.86 years. In contrast, the RSV-negative group included 80 men and 48 women, with an average age of 67.31 ± 13.55 years, and the difference was not statistically significant (P > 0.05). Nearly 96.8% of the patients in the RSV-positive group presented with underlying diseases. Of these, 49.2% had COPD, 1.6% had bronchial asthma, 31.8% had CHF, 7.9% had cardiac arrhythmias, 42.9% had hypertension, and 23.8% had diabetes. However, the difference in the prevalence of these conditions between RSV-positive and RSV-negative groups was not statistically significant (P > 0.05). The only exceptions were COPD and CHF, which were more prevalent among patients in the RSV-positive group with statistical significance (*P < 0.05). No substantial variations were evident in the occurrence rates of other conditions, such as bronchial asthma, cardiac arrhythmias, hypertension, and diabetes, between the two groups (P > 0.05). Moreover, the prevalence of obesity did not exhibit a statistically significant difference between the two groups (P > 0.05) (Table 1).

Table 1 Baseline characteristics of patients with severe LRTI: RSV-positive versus RSV-negative groups
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Clinical features and auxiliary examination characteristics of patients with severe LRTI infection: RSV-positive versus RSV-negative groups

The common clinical symptom in patients with severe LRTI in the RSV-positive group and those in the RSV-negative group was shortness of breath. Other symptoms in the descending order of prevalence were chest tightness, fever, headache, and myalgia in the RSV-positive group, whereas fever, headache, myalgia, and chest tightness in the RSV-negative group. Patients in the RSV-positive group were more likely to experience chest tightness and shortness of breath compared with those in the RSV-negative group, with a statistically significant difference (**P < 0.01). No statistically significant difference was observed between the two groups regarding myalgia, headache, fever, heart rate, and auscultatory findings, such as wet rales and wheezing sounds (P > 0.05). Patients in the RSV-positive group demonstrated significantly elevated monocyte count and monocyte ratio and decreased PaO2-to-FIO2 ratio at admission compared with RSV-negative patients (**P < 0.01, *P < 0.05, *P < 0.05). However, no statistically significant difference was noted in terms of white blood cell count, neutrophil count and ratio, lymphocyte count and ratio, NLR, ALT, AST, total bilirubin, creatinine, CK, CK-MB, LDH, CRP, APTT, PT, TT, fibrinogen, BNP, pH, PaCO2, and procalcitonin (P > 0.05). Regarding disease severity scores, no statistically significant differences were found in APACHE II, SOFA, or SIRS scores between the two groups (P > 0.05). Furthermore, patients in the RSV-positive group were more likely to have concomitant infections with other pathogens compared with RSV-negative patients, with a statistically significant difference (**P < 0.01). Patients in both groups exhibited pleural thickening, pulmonary fibrosis, pleural effusion, interstitial lesions, and double pneumonic infiltration. However, the possibility of double pneumonic infiltration was significantly higher in the RSV-positive group than in the RSV-negative group (*P < 0.05) (Table 2).

Table 2 Clinical features and auxiliary examination characteristics of patients with severe LRTI infection: RSV-positive versus RSV-negative groups
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Complication in patients with severe LRTI: RSV-positive versus RSV-negative groups

Patients in both RSV-positive and RSV-negative groups with severe LRTIs commonly experienced complications such as liver damage, kidney damage, sepsis, pulmonary encephalopathy, ARDS, MODS, and shock, with no statistically significant difference between the groups (P > 0.05) (Table 3).

Table 3 Complication in patients with severe LRTI: RSV-positive versus RSV-negative groups
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Treatment and prognosis of patients with severe LRTIs in the RSV-positive and RSV-negative groups

In terms of treatment and prognosis, patients with severe LRTIs in the RSV-positive group exhibited a higher rate of receiving noninvasive mechanical ventilation, and their hospitalization duration was longer compared with those in the RSV-negative group (**P < 0.01). However, no statistically significant difference was found between the two groups in terms of invasive ventilation treatment, use of vasoactive drugs, and hospital mortality rates (P > 0.05) (Table 4).

Table 4 Treatment and prognosis of patients with severe LRTIs in the RSV-positive and RSV-negative groups
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Logistic single-factor and multifactor regression analysis

A single-factor logistic regression analysis was conducted to compare the clinical characteristics of patients with severe LRTIs who tested positive and those who tested negative for RSV. Factors such as age, underlying disease, COPD, CHF, shortness of breath, chest tightness, monocyte count, monocyte ratio, PaO2-to-FIO2 ratio, pathogen detection, double pneumonic infiltration, noninvasive ventilation therapy, and hospitalization duration were incorporated in the analysis. The results revealed a statistically significant difference in age, underlying disease, COPD, CHF, platelet count and double pneumonic infiltration (all P < 0.05) as well as shortness of breath, chest tightness, oxygenation index, pathogen detection, noninvasive ventilation therapy, and hospitalization duration (all **P < 0.01) (Table 5). Subsequent multifactor logistic regression analysis demonstrated that the occurrence of chest tightness and decreased PaO2-to-FIO2 ratio was higher in patients with severe LRTIs in the RSV-positive group than in the RSV-negative group (respectively, *P < 0.05, **P < 0.01) (Table 6).

Table 5 Single-factor analysis of clinical characteristics in patients with severe lower respiratory tract infections: RSV-positive versus RSV-negative groups
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Table 6 Multifactor analysis of clinical characteristics in patients with severe lower respiratory tract infections: RSV-positive versus RSV-negative groups
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Kaplan–Meier survival analysis

Follow-up assessments were conducted until the most recent date of October 1, 2023. Of the 191 patients admitted with severe LRTIs, 11 deaths occurred in the RSV-positive group, resulting in a mortality rate of 17.5%. In the RSV-negative group, 19 deaths were recorded, yielding a mortality rate of 5.13%. As shown in Fig. 3A, the minimum and maximum survival durations for both cohorts were 0 and 3 months, respectively. The hospital mortality rates did not exhibit statistically significant differences between the two groups [adjusted hazards ratio (aHR), 0.87; confidence interval (CI), 0.41–1.85; P>0.05]. Incorporating data significantly associated with patients in the RSV-positive group from single-factor logistic regression analysis into Kaplan–Meier survival analysis indicated a substantial decline in the 90-day survival rate for elderly patients (aHR, 0.25; 95% CI, 0.07–0.84; *P = 0.025) and patients with CHF (aHR, 9.23; 95% CI, 2.46–34.56; **P = 0.001) or COPD (aHR, 4.38; 95% CI, 1.33–14.39; *P = 0.013) (Fig. 3B, C and D).

Fig. 3
figure 3

(A) Kaplan–Meier survival curves demonstrating the differences in survival rates between the RSV-positive and RSV-negative groups. Survival outcomes of patients with advanced age (B), CHF (C), and COPD (D) in the RSV-positive group

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Discussion

RSV infection is increasingly recognized as a significant cause of acute respiratory illness and exacerbation of underlying cardiopulmonary conditions in adults [2]. However, RSV infection has not received as much attention in society as other viral infections. Also, clinicians tend to overlook the increasing incidence and mortality rates of RSV infection in adults. This study contributes to our understanding of the clinical characteristics of severe RSV LRTIs in adults and aims to enhance societal and clinical awareness of severe RSV infection.

The peak incidence of patients with severe LRTI in the RSV-positive group was reported between November and February each year. This temporal pattern agreed with the findings of Nam et al. [12], who recorded a higher prevalence of RSV infections in the winter months, specifically peaking in December and January. Nevertheless, RSV-negative patients did not exhibit a seasonal trend, indicating the disparity in epidemiological characteristics between patients in the RSV-positive and RSV-negative groups.

Regarding baseline characteristics, patients with severe LRTI in the RSV-positive group were slightly older than those in the RSV-negative group. This could be attributed to the age-related decline in memory T-cell immune function in older individuals [11]. Furthermore, patients with COPD and CHF were more prone to RSV infection compared with RSV-negative patients. Our previous studies indicated that patients with chronic pulmonary diseases were more susceptible to RSV infection [12]. A recent prospective follow-up study of 445 patients aged ≥ 50 years with COPD and CHF revealed that 22% of the patients were diagnosed with RSV infection within 2–3 years, suggesting a high incidence in this population [13]. Furthermore, Prasad et al. [6]and Falsey et al. [14] proposed that the hospitalization rate for RSV LRTI was higher in patients with chronic cardiopulmonary diseases [4]. This finding confirmed that patients with combined COPD and CHF were more susceptible to RSV infection. These observations aligned with previous findings on adult RSV LRTIs but did not specifically focus on ICU-admitted patients.

Regarding clinical characteristics, shortness of breath was the most common symptom in patients with severe LRTI in the RSV-positive and RSV-negative groups. However, patients with severe LRTI in the RSV-positive group had a higher incidence of shortness of breath and chest tightness compared with those in the RSV-negative group. Regarding laboratory examinations, patients in the RSV-positive group exhibited significantly higher monocyte counts and ratios upon admission compared with those in the RSV-negative group. Monocytes are crucial as innate immune cells and display broad antiviral activity. Although these cells exert beneficial effects in viral infections, they also have unfavorable impacts on the host. Several studies have reported that monocytes can induce pathogenesis, ultimately leading to severe tissue damage via functional dysregulation such as enhancing the levels of inflammatory cytokines and chemokines and excessive interaction with adaptive immune cells and their products [15,16,17]. Furthermore, the oxygenation index was significantly lower in patients with severe LRTI in the RSV-positive group than those in the RSV-negative group. Previous studies have suggested that RSV infection can lead to increased shedding or detachment of the airway epithelium and accumulation in the narrow lumens of the distal bronchi, thereby resulting in acute obstruction of the distal airways [18, 19]. Hence, patients with severe RSV infection exhibit a significant reduction in the oxygenation index. In addition, RSV-infected patients are prone to concurrent infections with other pathogens [20]. The mechanism of concurrent infection may be related to factors such as damage to the respiratory epithelial cell barrier, alterations in airway function, increased susceptibility to other pathogens, upregulation of the expression of adhesion proteins, and dysregulation of host immune responses [21]. Patients with severe LRTI both in the RSV-positive and RSV-negative groups exhibited pleural thickening, pulmonary fibrosis, pleural effusion, interstitial lesions, double pneumonic infiltration, and so forth. However, double pneumonic infiltration was more likely in the RSV-positive group than in the RSV-negative group. No studies have specifically addressed this issue, necessitating further clinical analysis and documentation.

A comprehensive analysis of treatment interventions and prognostic outcomes revealed that patients with severe LRTIs and positive RSV tests were more likely to receive mechanical ventilation with extended hospital stay. However, statistically significant differences were not observed in the in-hospital mortality rates between the RSV-positive and RSV-negative groups. The current body of literature substantially supports these findings. These outcomes highlight the latent burden posed by RSV infection among adult ICU patients. Hence, effective preventive measures and timely therapeutic interventions are immensely important [22, 23]. Furthermore, the multifactorial regression analysis suggested a correlation of manifestations of chest tightness and diminished PaO2-to-FIO2 ratio with the severity of RSV infection in patients with severe LRTIs in the RSV-positive group.

In conclusion, the mortality rates in the initial 90 days of hospitalization for patients with severe LRTI in the RSV-positive group were systematically documented in this study. Advanced age, presence of CHF, and diagnosis of COPD were linked to a significant reduction in survival rates. These observations aligned with the findings of Tseng et al. [24], who reported a gradual decline in the 1-year survival rate among RSV-infected patients during hospitalization, especially in elderly individuals and patients with CHF or COPD. These findings highlight the importance of intensifying longitudinal follow-up for high-risk adults recuperating from RSV-associated hospitalization.

Nevertheless, this study had certain inherent limitations. First, completely relying on sputum as the testing specimen for all patients and the lack of results from alternative specimens, such as bronchoalveolar lavage fluid, throat swabs, and blood, introduced a potential constraint. Second, the single-center design of the study necessitates validation through multicenter investigations to enhance the generalizability of the findings. Furthermore, the relatively modest sample size of RSV-infected patients in this study underscores the need for a more extensive dataset to facilitate a comprehensive and rigorous analysis. Finally, the study did not involve an in-depth stratified analysis of RSV high-risk populations, particularly those with immunocompromised conditions requiring corticosteroid therapy or individuals undergoing long-term chemotherapy for malignant tumors. Future investigations should prioritize comprehensive characterization and mechanistic exploration within these vulnerable subgroups.

Conclusion

Patients with severe LRTIs in the RSV-positive group during ICU admission displayed prolonged hospitalization and a higher incidence of mechanical ventilation use compared with those in the RSV-negative group. Follow-up assessments implied that patients in the RSV-positive group with advanced age, CHF, and underlying COPD had reduced survival durations. Hence, early diagnosis and management of RSV infection are paramount in clinical practice.

Data availability

The datasets analyzed during the current study were made available from the corresponding author on reasonable request.

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Acknowledgements

None.

Funding

This work was supported by the National Natural Science Foundation of China (82360001; 82060010), Science and Technology Project of Guizhou Province (ZK[2022]581), Science and Technology Fund of Guizhou Provincial Health Commission [gzwkj2023-017], Guizhou Provincial Respiratory Critical Disease Clinical Research and Prevention and Treatment Talent Base Project ([2020]8) as well as the Science and Technology Bureau Project of Zunyi City (Zunshi Kehe HZ[2023]14).

Author information

Author notes

  1. Jiahua Tian, Ling Zhang and Xunling Wang contributed equally to this work.

Authors and Affiliations

  1. Department of Respiratory and Critical Care Medicine, The First People’s Hospital of Zunyi (The Third Affiliated Hospital of Zunyi Medical University), Zunyi, 563000, China

    Jiahua Tian, Ling Zhang, Guichuan Huang, Zhu Li & Ling Gong

  2. Department of Clinical Medicine, Zunyi Medical University, Zunyi, 563000, China

    Xunling Wang

  3. Department of Respiratory and Critical Care Medicine, Guizhou Provincial People’s Hospital, Guiyang, 550000, China

    Daishun Liu

  4. NHC Key Laboratory of Pulmonary Immunological Diseases, Guizhou Provincial People’s Hospital, Guiyang, Guizhou, 550002, China

    Daishun Liu

Authors
  1. Jiahua Tian
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  2. Ling Zhang
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  3. Xunling Wang
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  4. Guichuan Huang
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  5. Zhu Li
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  6. Ling Gong
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  7. Daishun Liu
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Contributions

TJH, ZL, WXL, GL and LDS designed the study. TJH and WXL collected clinical samples. TJH performed experiments. WXL and GL analyzed the data. HGC, LZ and ZL prepared and edited the initial manuscript. GL and LDS reviewed and revised the original manuscript. All authors read and approved the final manuscript.

Corresponding authors

Correspondence to Ling Gong or Daishun Liu.

Ethics declarations

Ethics approval and consent to participate

The study was approved by the Ethics Committees of The Fifth Affiliated (Zhuhai) Hospital of Zunyi Medical University (approval numbers: 2023ZH0035). All participants provided their written informed consent for this study.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.

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Tian, J., Zhang, L., Wang, X. et al. Clinical features and survival analysis of adult patients with severe lower respiratory tract infection positive for respiratory syncytial virus. BMC Pulm Med 25, 184 (2025). https://doi.org/10.1186/s12890-025-03660-7

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  • DOI: https://doi.org/10.1186/s12890-025-03660-7

Keywords

BMC Pulmonary Medicine

ISSN: 1471-2466

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