# Cardio–Renal Diseases Are Independent Risk Factors of Severe Human Metapneumovirus Infection Among Patients Without Chronic Airway Diseases

## TL;DR

Cardiovascular and kidney diseases increase the risk of severe outcomes in adults hospitalized with human metapneumovirus infections.

## Contribution

Identified cardio-renal diseases as independent risk factors for severe hMPV outcomes in non-airway disease patients.

## Key findings

- End-stage kidney disease requiring RRT is strongly linked to inpatient mortality and severe respiratory failure.
- Ischemic heart disease increases the risk of severe respiratory failure.
- Heart failure and ischemic stroke are significant predictors of acute kidney injury.

## Abstract

Human metapneumovirus (hMPV) causes mild and self‐limiting disease in adults. However, the risk factors for serious adverse outcomes following hMPV infection in adult patients without preexisting chronic airway diseases remain poorly understood. We conducted a territory‐wide retrospective study on adult patients (aged ≥ 18 years) without chronic airway diseases hospitalized for hMPV infections between January 1, 2016 and June 30, 2023 in Hong Kong. We assessed the incidence and risk factors for in‐patient mortality, severe respiratory failure (SRF), secondary bacterial pneumonia and acute kidney injury (AKI) were assessed. A total of 1552 eligible adult patients without chronic airway diseases hospitalized for hMPV infections were analyzed. Within the index admission, 92 (5.9%) patients died. Ischemic heart disease (IHD) was associated with increased risks of SRF [adjusted odds ratio (aOR) 2.00 (95% CI 1.48–2.71), p < 0.001]. IHD, heart failure (HF), and history of ischemic stroke were significant predictors for AKI [aOR 1.51 (95% CI 1.12–2.04), 2.87 (95% CI 2.14–3.85), and 1.47 (95% CI = 1.12–1.93), p = 0.007, < 0.001, and 0.005, respectively). Patients with end‐stage kidney disease (ESKD) requiring renal replacement therapy (RRT) were at increased risk of in‐patient mortality [aOR 6.36 (95% CI 2.34–17.26), p < 0.001] and SRF [aOR 8.80 (95% CI 3.84–20.16), p < 0.001]. The presence of cardiovascular diseases and ESKD requiring RRT is a strong predictor of severe in‐hospital outcomes among adult patients without chronic airway diseases who are hospitalized for hMPV infections.