@article{Morelli:2026:10.1136/thorax-2025-224192,
author = {Morelli, T and Purcell, M and Panaguiton, J and Patel, R and Weinberg, S and Hulston, G and Siy-Yap, H and Davies, EA and Keating, A and Saidy, I and Freeman, A and Staples, KJ and Rodrigues, P and Jones, A and Allen, A and Bansal, AT and Marciniak, SJ and Greening, NJ and Crooks, MG and Mitchelmore, P and Siddiqui, SH and Myerson, J and Pavitt, MJ and Daneshvar, C and Chalmers, JD and Lee, PH and Lewis, T and Clark, TW and Denny, S and Wiseman, DJ and Ellis, H and Wilkinson, TM and UNIVERSAL, Study Group and Universal, Study Group},
doi = {10.1136/thorax-2025-224192},
journal = {Thorax},
title = {Understanding risk of poor outcomes in adults hospitalised with respiratory syncytial virus infection: evidence from a multicentre UK cohort.},
url = {http://dx.doi.org/10.1136/thorax-2025-224192},
year = {2026}
}

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TY  - JOUR
AB  - 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 st
AU  - Morelli,T
AU  - Purcell,M
AU  - Panaguiton,J
AU  - Patel,R
AU  - Weinberg,S
AU  - Hulston,G
AU  - Siy-Yap,H
AU  - Davies,EA
AU  - Keating,A
AU  - Saidy,I
AU  - Freeman,A
AU  - Staples,KJ
AU  - Rodrigues,P
AU  - Jones,A
AU  - Allen,A
AU  - Bansal,AT
AU  - Marciniak,SJ
AU  - Greening,NJ
AU  - Crooks,MG
AU  - Mitchelmore,P
AU  - Siddiqui,SH
AU  - Myerson,J
AU  - Pavitt,MJ
AU  - Daneshvar,C
AU  - Chalmers,JD
AU  - Lee,PH
AU  - Lewis,T
AU  - Clark,TW
AU  - Denny,S
AU  - Wiseman,DJ
AU  - Ellis,H
AU  - Wilkinson,TM
AU  - UNIVERSAL,Study Group
AU  - Universal,Study Group
DO  - 10.1136/thorax-2025-224192
PY  - 2026///
TI  - Understanding risk of poor outcomes in adults hospitalised with respiratory syncytial virus infection: evidence from a multicentre UK cohort.
T2  - Thorax
UR  - http://dx.doi.org/10.1136/thorax-2025-224192
UR  - https://www.ncbi.nlm.nih.gov/pubmed/41644135
ER  - 

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