Adults hospitalised with viral lower respiratory tract disease (LRTD) continue to experience substantial morbidity, mortality, and healthcare costs, according to a large retrospective analysis of nearly 390,000 patients in the USA.
The study examined clinical outcomes among adults hospitalised with viral LRTD between January 2015 and March 2023, providing one of the most comprehensive assessments of disease burden spanning the pre-pandemic, pandemic, and post-pandemic periods.
Significant Burden Across Viral Infections
Researchers analysed data from 387,449 adults identified through a large US healthcare claims database. The study included hospitalisations linked to a range of viral respiratory infections and assessed outcomes including intensive care unit (ICU) admission, ventilation requirements, mortality, readmissions, and healthcare costs.
Overall, more than one-third of patients (38.1%) required ICU admission within 30 days of hospitalisation. Most ICU admissions occurred immediately, with nearly 85% taking place on the index admission date.
The need for respiratory support was also common. Within 30 days of admission, 8.4% of patients received non-invasive ventilation, while 8.7% required invasive mechanical ventilation or extracorporeal membrane oxygenation (ECMO).
Mortality Remained Substantial
The analysis found that viral LRTD was associated with considerable mortality. Overall, 15.1% of patients died within 30 days of hospitalisation.
Researchers noted that severe outcomes were observed across all viral causes included in the study, highlighting the broader impact of viral respiratory infections beyond COVID-19 alone.
The findings reinforce concerns that viral LRTD remains a major cause of serious illness among adults, particularly those requiring hospital care.
High Costs and Prolonged Hospitalisation
Hospitalisations were associated with significant resource utilisation. The median hospital stay was 7 days, although many patients required considerably longer admissions.
Average hospitalisation costs exceeded $42,000 per patient, reflecting the intensive level of care often required. Costs were particularly elevated among patients experiencing severe disease and those requiring critical care interventions.
Pandemic Peak, Persistent Impact
The burden of viral LRTD reached its highest levels during 2020–2021, when ICU admissions, mortality rates, and healthcare costs peaked during the COVID-19 pandemic.
However, the study found that readmission rates and healthcare expenditures remained elevated even during the 2022–2023 period, suggesting that the healthcare impact of severe viral respiratory infections extends well beyond the height of the pandemic.
Implications for Healthcare Planning
The authors concluded that viral LRTD continues to place a substantial strain on healthcare systems regardless of the specific viral cause. Frequent ICU admissions, ventilation requirements, high mortality, and significant costs underscore the ongoing clinical and economic burden of these infections.
The findings highlight the importance of prevention strategies, early identification of high-risk patients, and continued investment in therapies and public health measures aimed at reducing severe respiratory viral disease.
Reference
Maslova E et al. Clinical outcomes and costs associated with viral lower respiratory tract disease hospitalisations. BMJ Open Respiratory Research. 2026;13:e003552.
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