Interplay of risk factors and complications in severe outcomes of acute respiratory infections: A multicenter study in China
1
National Institute of Pathogen Biology, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
2
School of Population Medicine and Public Health, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China
3
Shandong Provincial Center for Disease Control and Prevention, Shandong, China
4
Chongqing Center for Disease Control and Prevention, Chongqing, China
Popul. Med. 2026;8(Supplement Supplement 1):
ABSTRACT
BACKGROUND:
Acute respiratory infections (ARIs), particularly pneumonia, can deteriorate into critical illness or death. We sought to identify determinants of these severe outcomes.
METHODS:
We conducted a cross-sectional study across 31 Chinese hospitals from December 2022 to July 2024. Oropharyngeal swabs (outpatients) and bronchoalveolar lavage fluid (inpatients) from patients with acute respiratory infections (ARIs) were tested for eight pathogens. Generalized additive models estimated the risk of pneumonia, bronchitis, or cardio-cerebrovascular complications (CVCCs). A parallel mediation model was used to assess direct and indirect pathways linking risk factors, complications, and intensive care unit (ICU) admission.
RESULTS:
Among the 5,063 included ARI patients, 2.0% developed CVCCs, and 1.8% required ICU admission. CT-confirmed pneumonia was present in 56.5%, and bronchitis in 8.7%. Influenza virus (IFV) infection was associated with bronchitis (odds ratio [OR], 1.70; 95% confidence interval [CI]: 1.02–2.84). Respiratory syncytial virus (RSV) infection (OR, 3.28; CI: 1.28–8.43) and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection (OR, 1.67; CI: 1.15–2.43) were associated with pneumonia. Patients with pre-existing cardiovascular disease (CVD) (OR: 4.71; CI: 2.89–7.70), chronic obstructive pulmonary disease (OR: 1.99; CI: 1.29–3.05), chronic liver diseases (OR: 4.40; CI: 1.42–13.68), or autoimmune diseases (OR: 11.90; CI: 2.71–52.29) had a higher risk of developing CVCCs. A history of CVD, asthma, autoimmune diseases, and neuromuscular diseases was directly associated with an increased risk of ICU admission (P<0.001). Notably, CVD also had an indirect effect on this outcome through the mediation of CVCCs (P=0.004).
CONCLUSIONS:
Pneumonia and bronchitis exhibit distinct seasonal patterns. SARS-CoV-2, RSV, and IFV are major drivers of respiratory complications, while chronic medical conditions strongly predict CVCCs and mortality. In patients with CVD, CVCCs may act as a mediating factor in the progression from ARI to ICU admission. Early recognition can guide targeted therapies and reduce ARI critical-care demand.
Acute respiratory infections (ARIs), particularly pneumonia, can deteriorate into critical illness or death. We sought to identify determinants of these severe outcomes.
METHODS:
We conducted a cross-sectional study across 31 Chinese hospitals from December 2022 to July 2024. Oropharyngeal swabs (outpatients) and bronchoalveolar lavage fluid (inpatients) from patients with acute respiratory infections (ARIs) were tested for eight pathogens. Generalized additive models estimated the risk of pneumonia, bronchitis, or cardio-cerebrovascular complications (CVCCs). A parallel mediation model was used to assess direct and indirect pathways linking risk factors, complications, and intensive care unit (ICU) admission.
RESULTS:
Among the 5,063 included ARI patients, 2.0% developed CVCCs, and 1.8% required ICU admission. CT-confirmed pneumonia was present in 56.5%, and bronchitis in 8.7%. Influenza virus (IFV) infection was associated with bronchitis (odds ratio [OR], 1.70; 95% confidence interval [CI]: 1.02–2.84). Respiratory syncytial virus (RSV) infection (OR, 3.28; CI: 1.28–8.43) and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection (OR, 1.67; CI: 1.15–2.43) were associated with pneumonia. Patients with pre-existing cardiovascular disease (CVD) (OR: 4.71; CI: 2.89–7.70), chronic obstructive pulmonary disease (OR: 1.99; CI: 1.29–3.05), chronic liver diseases (OR: 4.40; CI: 1.42–13.68), or autoimmune diseases (OR: 11.90; CI: 2.71–52.29) had a higher risk of developing CVCCs. A history of CVD, asthma, autoimmune diseases, and neuromuscular diseases was directly associated with an increased risk of ICU admission (P<0.001). Notably, CVD also had an indirect effect on this outcome through the mediation of CVCCs (P=0.004).
CONCLUSIONS:
Pneumonia and bronchitis exhibit distinct seasonal patterns. SARS-CoV-2, RSV, and IFV are major drivers of respiratory complications, while chronic medical conditions strongly predict CVCCs and mortality. In patients with CVD, CVCCs may act as a mediating factor in the progression from ARI to ICU admission. Early recognition can guide targeted therapies and reduce ARI critical-care demand.
| eISSN: | 2654-1459 |
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