{
  "abstract": "Background Respiratory syncytial virus (RSV) causes substantial winter pressure on adult services. In the UK, RSV vaccination currently targets adults aged ≥75 years and care home residents; it remains uncertain whether this age criterion alone meaningfully discriminates risk of poor outcome among adults hospitalised with RSV.Methods We pooled three UK hospital cohorts (one prospective, two retrospective) of adults admitted with acute respiratory infection (ARI) and PCR-confirmed RSV. The primary outcome was intensive care unit/high dependency unit (ICU/HDU) admission or all-cause mortality within 60 days. Prespecified predictors (age, sex and comorbidities) entered a least absolute shrinkage and selection operator (LASSO) penalised logistic regression; selected variables were refitted using standard logistic regression. Discrimination, calibration and decision-analytic performance were assessed using 1000-bootstrap internal validation and decision-curve analysis.Results Among 334 adults, 37 (11.1%) experienced the primary outcome. An age-only rule mirroring current UK vaccine age-eligibility (≥75 years) demonstrated only modest discrimination (optimism-adjusted area under the receiver operating characteristic curve (AUC) 0.58, 95% CI 0.48 to 0.65) and a compressed distribution of predicted risks. A four-predictor model—including age, COPD, active/previous cancer and dementia—achieved higher discrimination AUC (0.77 (0.69 to 0.85)), a wider spread of predicted risks and the greatest net benefit across clinically plausible escalation thresholds (5–20%).Conclusions In adults hospitalised with RSV-associated ARI, simple age-based heuristics—including the UK ≥75-year threshold—showed only modest ability to discriminate risk of ICU/HDU admission/60-day mortality once hospitalised. Comorbidity-inclusive approaches may provide more informative hospital-level risk stratification and warrant evaluation in future RSV vaccine-effectiveness and outcome studies. Any application requires external validation, more systematic RSV testing and comparison with physiology-based scores in larger, vaccinated cohorts.",
  "authors": [
    {
      "affiliations": [
        "Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK",
        "NIHR Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK"
      ],
      "name": "Tommaso Morelli"
    },
    {
      "affiliations": [
        "Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK",
        "NIHR Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK"
      ],
      "name": "Martha Purcell"
    },
    {
      "affiliations": [
        "Guy's and St Thomas’ Hospitals NHS Trust, London, UK"
      ],
      "name": "Jon Panaguiton"
    },
    {
      "affiliations": [
        "Royal Devon University Healthcare NHS Foundation Trust, Exeter, UK"
      ],
      "name": "Rachel Patel"
    },
    {
      "affiliations": [
        "Manchester University NHS Foundation Trust, Manchester, UK"
      ],
      "name": "Sharon Weinberg"
    },
    {
      "affiliations": [
        "Manchester University NHS Foundation Trust, Manchester, UK"
      ],
      "name": "George Hulston"
    },
    {
      "affiliations": [
        "Manchester University NHS Foundation Trust, Manchester, UK"
      ],
      "name": "Hans Siy-Yap"
    },
    {
      "affiliations": [
        "Manchester University NHS Foundation Trust, Manchester, UK"
      ],
      "name": "Emma A Davies"
    },
    {
      "affiliations": [
        "Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK",
        "NIHR Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK"
      ],
      "name": "Anluan Keating"
    },
    {
      "affiliations": [
        "Manchester University NHS Foundation Trust, Manchester, UK"
      ],
      "name": "Ida Saidy"
    },
    {
      "affiliations": [
        "Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK",
        "NIHR Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK"
      ],
      "name": "Anna Freeman"
    },
    {
      "affiliations": [
        "Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK",
        "NIHR Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK"
      ],
      "name": "Karl J Staples"
    },
    {
      "affiliations": [
        "Clinical Trials Unit, University of Southampton, Southampton, UK"
      ],
      "name": "Pedro Rodrigues"
    },
    {
      "affiliations": [
        "Clinical Trials Unit, University of Southampton, Southampton, UK"
      ],
      "name": "Abigail Jones"
    },
    {
      "affiliations": [
        "Clinical Trials Unit, University of Southampton, Southampton, UK"
      ],
      "name": "Alexander Allen"
    },
    {
      "affiliations": [
        "Acclarogen Ltd, Cambridge, UK"
      ],
      "name": "Aruna T Bansal"
    },
    {
      "affiliations": [
        "Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK",
        "Royal Papworth Hospital, Cambridge, UK"
      ],
      "name": "Stefan J Marciniak"
    },
    {
      "affiliations": [
        "Department of Respiratory Sciences, Institute for Lung Health, University of Leicester, Leicester, UK"
      ],
      "name": "Neil J Greening"
    },
    {
      "affiliations": [
        "Respiratory Research Group, Hull York Medical School, Hull, UK"
      ],
      "name": "Michael G Crooks"
    },
    {
      "affiliations": [
        "Royal Devon University Healthcare NHS Foundation Trust, Exeter, UK"
      ],
      "name": "Philip Mitchelmore"
    },
    {
      "affiliations": [
        "National Heart and Lung Institute, Imperial College London, London, UK"
      ],
      "name": "Salman H Siddiqui"
    },
    {
      "affiliations": [
        "University Hospitals Sussex NHS Foundation Trust, Brighton and Haywards Heath, UK"
      ],
      "name": "James Myerson"
    },
    {
      "affiliations": [
        "University Hospitals Sussex NHS Foundation Trust, Brighton and Haywards Heath, UK"
      ],
      "name": "Matthew J Pavitt"
    },
    {
      "affiliations": [
        "Department of Respiratory Medicine, Plymouth Hospitals NHS Trust, Plymouth, UK"
      ],
      "name": "Cyrus Daneshvar"
    },
    {
      "affiliations": [
        "Division of Respiratory Medicine and Gastroenterology, Ninewells Hospital and Medical School, University of Dundee, Dundee, UK"
      ],
      "name": "James D Chalmers"
    },
    {
      "affiliations": [
        "Clinical Trials Unit, University of Southampton, Southampton, UK"
      ],
      "name": "Paul H Lee"
    },
    {
      "affiliations": [
        "Royal Devon University Healthcare NHS Foundation Trust, Exeter, UK"
      ],
      "name": "Tom Lewis"
    },
    {
      "affiliations": [
        "Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK",
        "NIHR Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK"
      ],
      "name": "Tristan W Clark"
    },
    {
      "affiliations": [
        "Chelsea and Westminster Hospital NHS Foundation Trust, London, UK"
      ],
      "name": "Sarah Denny"
    },
    {
      "affiliations": [
        "Chelsea and Westminster Hospital NHS Foundation Trust, London, UK"
      ],
      "name": "Dexter J Wiseman"
    },
    {
      "affiliations": [
        "Manchester University NHS Foundation Trust, Manchester, UK"
      ],
      "name": "Huw Ellis"
    },
    {
      "affiliations": [
        "Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK",
        "NIHR Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK"
      ],
      "name": "Tom MA Wilkinson"
    },
    {
      "affiliations": [],
      "name": "UNIVERSAL Study Group"
    }
  ],
  "title": "Understanding risk of poor outcomes in adults hospitalised with respiratory syncytial virus infection: evidence from a multicentre UK cohort",
  "uid": "5225c5f9-5c4d-5326-8bde-dd5a77b1a62a"
}