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A Multicenter Outcomes Analysis of Children With Severe Viral Respiratory Infection Due to Human Metapneumovirus

Spaeder, Michael C. MD1; Custer, Jason W. MD2; Bembea, Melania M. MD3; Aganga, Devon O. MD3; Song, Xiaoyan MBBS, PhD4; Scafidi, Susanna MD2

Pediatric Critical Care Medicine: March 2013 - Volume 14 - Issue 3 - p 268–272
doi: 10.1097/PCC.0b013e3182720fc7
Feature Article

Objective: To investigate the impact of human metapneumovirus on morbidity and mortality outcomes in children with severe viral respiratory infection.

Design: Retrospective cohort study.

Setting: ICU, either PICU or cardiac ICU, at three urban academic tertiary care children’s hospitals.

Patients: All patients admitted to an ICU with laboratory-confirmed human metapneumovirus infection between January 2010 and June 2011.

Interventions: We captured demographic and clinical data and analyzed associated morbidity and mortality outcomes.

Measurements and Main Results: There were 111 patients with laboratory-confirmed human metapneumovirus admitted to an ICU at one of the three participating institutions during the period of study. The median hospital length of stay was 7 days (interquartile range 4–18 days) and median ICU length of stay was 4 days (interquartile range 1–10 days). Ten patients (9%) did not survive to discharge. Predisposing factors associated with increased mortality included female gender (p = 0.002), presence of a chronic medical condition (p = 0.04), and hospital acquisition of human metapneumovirus infection (p = 0.006). Adjusting for female gender, chronic medical conditions, hospital acquisition of infection and severity of illness score, logistic regression analysis demonstrated that female gender, hospital acquisition of infection, and chronic medical conditions each independently increased the odds of mortality (odds ratios 14.8, 10.7, and 12.7, respectively).

Conclusions: Analysis of our results suggests that there is substantial morbidity and mortality associated with severe viral respiratory infection due to human metapneumovirus in children. Female gender, hospital acquisition of human metapneumovirus infection, and presence of chronic medical conditions each independently increases mortality. The burden of illness from human metapneumovirus on the ICU in terms of resource utilization may be considerable.

1Division of Critical Care Medicine, Children’s National Medical Center, Washington, DC.

2Division of Pediatric Critical Care Medicine, University of Maryland Medical Center, Baltimore, MD.

3Division of Pediatric Anesthesiology and Critical Care Medicine, Johns Hopkins Hospital, Baltimore, MD.

4Division of Pediatric Infectious Disease, Children’s National Medical Center, Washington, DC.

All work pertinent to this manuscript was conducted at the Children’s National Medical Center, the Johns Hopkins Hospital, and the University of Maryland Medical Center.

The authors have not disclosed any potential conflicts of interest.

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©2013The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies