# Risk factors for ICD-10-coded Respiratory Syncytial Virus-associated deaths in hospitalized patients in Germany before the COVID-19 pandemic (nationwide in-patient data, 2010–2019)

## TL;DR

This study identifies risk factors for death from RSV in hospitalized patients in Germany before the pandemic, focusing on age and underlying health conditions.

## Contribution

The study provides new insights into age-specific risk factors for RSV-related in-hospital mortality using nationwide data in Germany.

## Key findings

- Seniors over 59 years had the highest RSV-related in-hospital mortality rate.
- Chronic conditions like cardiovascular and respiratory diseases increased mortality risk in children and adults.
- Acute respiratory distress syndrome and sepsis were fatal risk factors across all age groups.

## Abstract

We compared nationwide data on the clinical characteristics of deceased and non-deceased patients with Respiratory Syncytial Virus (RSV)-coded hospitalization to evaluate potential risk factors for in-hospital fatality by age group.

Data from International Statistical Classification of Diseases (10th Revision)-based German Hospital Statistics for patients from 2010–2019 with a primary discharge diagnosis code for RSV-related pneumonia (J12.1), bronchitis (J20.5) or bronchiolitis (J21.0) were assessed by remote data retrieval. Selected underlying conditions and complications were reported stratified by age group and outcome.

Overall, 612 (0.3% of 205,352) RSV-coded patients died in hospital (103 children < 18 years, 51 adults 18–59 years, 458 seniors > 59 years). Children and adults with underlying chronic cardiovascular, neurological, immunological, or lower respiratory diseases had a higher risk of dying than those without (Odds Ratio 109, 58, 28, 6 in children, and 3, 3, 3, 2 in adults). In seniors, the risk was increased for patients with chronic neurological conditions (OR 1.3) but not for other underlying conditions. Acute respiratory distress syndrome, sepsis and pneumonia increased the risk of a fatal outcome in all age groups.

In-hospital fatality of RSV-coded patients varied considerably with age, chronic conditions and complications. Seniors were the most affected age group and may therefore benefit from the RSV vaccination recommended in Germany since 2024 for all over 75 years and seniors with pre-existing conditions.