Diabetes and bacterial co-infection are two independent risk factors for respiratory syncytial virus disease severity

Hakan Sivgin; Sirin Cetin; Ayse Ulgen; Wentian Li

doi:10.3389/fmed.2023.1231641

Diabetes and bacterial co-infection are two independent risk factors for respiratory syncytial virus disease severity

Front Med (Lausanne). 2023 Nov 1:10:1231641. doi: 10.3389/fmed.2023.1231641. eCollection 2023.

Authors

Hakan Sivgin¹, Sirin Cetin², Ayse Ulgen^{3

4}, Wentian Li^{5

6}

Affiliations

¹ Department of Internal Medicine, Faculty of Medicine, Tokat GaziosmanPasa University, Tokat, Türkiye.
² Department of Biostatistics, Faculty of Medicine, Amasya University, Amasya, Türkiye.
³ Department of Biostatistics, Faculty of Medicine, Girne American University, Karmi, Cyprus.
⁴ Department of Mathematics, School of Science and Technology, Nottingham Trent University, Nottingham, United Kingdom.
⁵ Department of Applied Mathematics and Statistics, Stony Brook University, Stony Brook, NY, United States.
⁶ The Robert S. Boas Center for Genomics and Human Genetics, The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, United States.

Abstract

Diabetes mellitus (DM) is common among older adults hospitalized with lower respiratory tract infection, yet information on the impact of DM on disease severity is limited. This study retrospectively analyzed 46 Turkish patients infected with respiratory syncytial virus (RSV), with information on their comorbidities, co-infection status, and symptoms. Patients are grouped into four severity levels from mild to severe, according to lung parenchymal infiltration status and oxygen level. Similar to previously published studies, we found that comorbidities of diabetes, heart failure, hypertension, co-infection of any type, bacterial co-infection, and age are associated with the disease severity. Cough is the most common symptom (89%) followed by fever (26%) and myalgia, dyspnea, and weakness (around 20%). Using a second-order analysis (two-variable regression), we identified two independent risks for disease severity, the first is represented by diabetes, and the second is represented by bacterial co-infection. We observed two patients whose more severe symptoms were not associated with an older age, but associated with a combination of diabetes and bacterial co-infection. To confirm the true causality from the statistical correlation, further studies are needed.

Keywords: bacterial coinfection; chronic medical condition; diabetes mellitus; disease severity; respiratory syncytial virus (RSV).