Disease severity and clinical outcomes of community acquired pneumonia caused by non-influenza respiratory viruses in adults: a multicenter prospective registry study from CAP-China Network.

Zhou, Fei; Wang, Yimin; Liu, Yingmei; Liu, Xuedong; Gu, Li; Zhang, Xiaoju; Pu, Zenghui; Yang, Guoru; Liu, Bo; Nie, Qingrong; Xue, Bing; Feng, Jing; Guo, Qiang; Liu, Jianhua; Fan, Hong; Chen, Jin; Zhang, Yongxiang; Xu, Zhenyang; Pang, Min; Chen, Yu; Nie, Xiuhong; Cai, Zhigang; Xu, Jinfu; Peng, Kun; Li, Xiangxin; Xiang, Pingchao; Zhang, Zuoqing; Jiang, Shujuan; Su, Xin; Zhang, Jie; Li, Yanming; Jin, Xiuhong; Jiang, Rongmeng; Dong, Jianping; Song, Yuanlin; Zhou, Hong; Wang, Chen; Cao, Bin

Although a wide knowledge of influenza viral pneumonia have been established, the significance of non-influenza respiratory viruses in community acquired pneumonia (CAP) and their impact on clinical outcomes remains unclear, especially in non-immunocompromised adult population. Hospitalised immunocompetent patients with CAP were prospectively recruited from 34 hospitals in Mainland China. Respiratory viruses were detected by molecular methods. Comparisons were conducted between influenza and non-influenza viral-infection groups. In total, 915 of 2336 adult patients with viral infection were enrolled in the analysis with influenza virus (28.4%) most frequently detected, followed by respiratory syncytial virus (3.6%), adenovirus (3.3%), human coronavirus (3.0%), parainfluenza virus (2.2%), human rhinovirus (1.8%), and human metapneumovirus (1.5%). Non-influenza viral infections accounted for 27.4% of viral pneumonia. Consolidation was more frequently observed in patients with adenovirus infection. The occurrence of complications such as sepsis (40.1% versus 39.6%, p=0.890) and hypoxemia (40.1% versus 37.2%, p=0.449) during hospitalisation in influenza group didn't differ from that of non-influenza group. Compared with influenza viral infection, the multivariable-adjusted odds ratios and 95% confidence intervals (CIs) of CURB-65 >3, PaO2/FiO2 <200 mmHg, and occurrence of sepsis or hypoxemia for non-influenza viral infection were 0.87 (0.26-2.84), 0.72 (0.26-1.98), 1.00 (1.63-1.58), and 1.05 (0.66-1.65), respectively. The hazard ratio and 95% CI of 90-day mortality was 0.51 (0.13-1.91). The high incidence of complications in non-influenza viral pneumonia and similar impact of non-influenza viruses relative to influenza virus on disease severity and outcomes suggest more attention should be given to CAP caused by non-influenza viruses.