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Title	Disease severity and clinical outcomes of community-acquired pneumonia caused by non-influenza respiratory viruses in adults: a multicentre prospective registry study from the CAP-China Network.
Author	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
Journal	Eur Respir J	Publication Year/Month	2019-Aug
PMID	31164430	PMCID	-N/A-
Affiliation + expend	1.Dept of Pulmonary and Critical Care Medicine, Center for Respiratory Diseases, China-Japan Friendship Hospital, Institute of Respiratory Medicine Chinese Academy of Medical Science, National Clinical Research Center of Respiratory Diseases, Beijing, China.
	2.Clinical Center for Pulmonary Infections, Capital Medical University, Beijing, China.
	3.Tsinghua University-Peking University Joint Center for Life Sciences, Beijing, China.
	4.These authors contributed equally to this work.
	5.Dept of Respiratory Medicine, Qingdao Municipal Hospital, Qingdao, China.
	6.Dept of Infectious Diseases, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China.
	7.Dept of Respiratory Medicine, Henan Provincial People's Hospital, Zhengzhou, China.
	8.Dept of Infectious Diseases, Yantai Yu Huang-Ding Hospital, Yantai, China.
	9.Dept of Pulmonary and Critical Care Medicine, Weifang No. 2 People's Hospital, Weifang, China.
	10.Dept of Respiratory and Critical Care Medicine, Linzi District People's Hospital, Zibo, China.
	11.Dept of Respiratory and Critical Care Medicine, Liangxiang Hospital, Beijing, China.
	12.Dept of Respiratory Medicine, Chuiyangliu Hospital Affiliated to Tshinghua University, Beijing, China.
	13.Dept of Respiratory Medicine, General Hospital of Tianjin Medical University, Tianjin, China.
	14.Dept of Respiratory, Emergency and Critical Care Medicine, First Affiliated Hospital of Soochow University, Jiangsu, China.
	15.Dept of Respiratory Medicine, Beijing Huairou Hospital of University of Chinese Academy of Science, Beijing, China.
	16.Dept of Pulmonary and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China.
	17.Dept of Respiratory Medicine, Fuxing Hospital, Capital Medical University, Beijing, China.
	18.Dept of Respiratory Medicine, Daxing Teaching Hospital, Capital Medical University, Beijing, China.
	19.Dept of Pulmonary and Critical Care Medicine, Beijing Luhe Hospital, Capital Medical University, Beijing, China.
	20.Dept of Respiratory Medicine, First Hospital of Shanxi Medical University, Taiyuan, China.
	21.Dept of Pulmonary and Critical Care Medicine, Shengjing Hospital of China Medical University, Beijing China.
	22.Dept of Respiratory Medicine, Xuanwu Hospital, Capital Medical University, Beijing, China.
	23.Dept of Pulmonary and Critical Care Medicine, Second Hospital of Hebei Medical University, Shijiazhuang, China.
	24.Dept of Pulmonary and Critical Care Medicine, Shanghai Pulmonary Hospital, Shanghai, China.
	25.Dept of Respiratory Medicine, Beijing No. 6 Hospital, Beijing, China.
	26.Dept of Pulmonary and Critical Care Medicine, Beijing Changping Hospital, Beijing, China.
	27.Dept of Pulmonary and Critical Care Medicine, Peking University Shougang Hospital, Beijing, China.
	28.Dept of Respiratory Medicine, Beijing Shijingshan Hospital, Beijing, China.
	29.Dept of Pulmonary and Critical Care Medicine, Shandong Province Hospital, Jinan, China.
	30.Dept of Respiratory Medicine, Nanjing General Hospital of Nanjing Military Command, PLA, Nanjing, China.
	31.Dept of Respiratory Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
	32.Dept of Pulmonary and Critical Care Medicine, Beijing Hospital, Beijing, China.
	33.Dept of Respiratory Medicine, Beijing Pinggu Hospital, Beijing, China.
	34.Infectious Disease Diagnosis and Treatment Center, Beijing Ditan Hospital, Capital Medical University, Beijing, China.
	35.Dept of Infectious Diseases, Beijing Haidian Hospital, Haidian Section of Peking University Third Hospital, Beijing, China.
	36.Dept of Pulmonary and Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China.
	37.Dept of Respiratory Medicine, Beijing Electric Power Hospital, Beijing, China.
	38.Dept of Pulmonary and Critical Care Medicine, Center for Respiratory Diseases, China-Japan Friendship Hospital, Institute of Respiratory Medicine Chinese Academy of Medical Science, National Clinical Research Center of Respiratory Diseases, Beijing, China caobin_ben@163.com.

Abstract

Although broad knowledge of influenza viral pneumonia has been established, the significance of non-influenza respiratory viruses in community-acquired pneumonia (CAP) and their impact on clinical outcomes remains unclear, especially in the 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 out of 2336 adult patients with viral infection were enrolled in the analysis, with influenza virus (28.4%) the most frequently detected virus, 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 hypoxaemia (40.1% versus 37.2%; p=0.449) during hospitalisation in the influenza viral infection group did not differ from that of the non-influenza viral infection group. Compared with influenza virus infection, the multivariable adjusted odds ratios of CURB-65 (confusion, urea >7 mmol.L(-1), respiratory rate >/=30 breaths.min(-1), blood pressure <90 mmHg (systolic) or </=60 mmHg (diastolic), age >/=65 years) >/=3, arterial oxygen tension/inspiratory oxygen fraction <200 mmHg, and occurrence of sepsis and hypoxaemia for non-influenza respiratory virus infection were 0.87 (95% CI 0.26-2.84), 0.72 (95% CI 0.26-1.98), 1.00 (95% CI 0.63-1.58) and 1.05 (95% CI 0.66-1.65), respectively. The hazard ratio of 90-day mortality was 0.51 (95% CI 0.13-1.91).The high incidence of complications in non-influenza viral pneumonia and similar impact of non-influenza respiratory viruses relative to influenza virus on disease severity and outcomes suggest more attention should be given to CAP caused by non-influenza respiratory viruses.

MeSH terms

Pneumonia, Viral/*therapy/virology

Respiratory Tract Infections/therapy/*virology

Adolescent

Adult

Aged

Aged, 80 and over

China/epidemiology

Community-Acquired Infections/therapy/virology

Female

Geography

Hospitalization