{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T12:31:14Z","timestamp":1787142674386,"version":"build-2736575974"},"reference-count":31,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2026,4,8]],"date-time":"2026-04-08T00:00:00Z","timestamp":1775606400000},"content-version":"vor","delay-in-days":9,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"name":"Norwegian Association for Pulmonary Medicine"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,3,30]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>This retrospective cohort study compares the risk and severity of acute respiratory failure (ARF) among adults hospitalized with different respiratory viruses.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We included 4927 adults admitted to Akershus University Hospital, Norway, from 2012 to 2021 with polymerase chain reaction\u2013confirmed viral infection with influenza A\/B, respiratory syncytial virus (RSV), parainfluenza virus (PIV), human metapneumovirus, or severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). ARF was defined as the use of high-flow oxygen, noninvasive ventilation, or mechanical ventilation during the hospital admission. Logistic regression models estimated adjusted probabilities of respiratory failure and ventilatory support, using influenza A\/B as the reference, with adjustment for age, sex, National Early Warning Score 2 (NEWS2), weighted Charlson Comorbidity Index, and other covariates.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Overall, 11.8% of patients (n = 583) met the criteria for ARF. Compared with influenza A\/B, all other virus groups except human metapneumovirus were associated with a higher adjusted probability of ARF. SARS-CoV-2 showed the highest risk, followed by PIV and RSV (all P &amp;lt; .01). A similar pattern was seen for noninvasive or mechanical ventilation. Sensitivity analyses using alternative comorbidity adjustments or analyzing patients before and after the coronavirus disease 2019 pandemic separately produced consistent relative rankings across virus groups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>SARS-CoV-2, PIV, and RSV were associated with increased risk of ARF in hospitalized adults compared with influenza A\/B. SARS-CoV-2 strains circulating during the early pandemic showed the greatest risk, while RSV and PIV also conferred a substantial excess ARF risk. These findings underscore the need for clinical vigilance and preventive strategies in patients admitted with viral respiratory tract infections.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ofid\/ofag189","type":"journal-article","created":{"date-parts":[[2026,4,7]],"date-time":"2026-04-07T11:28:43Z","timestamp":1775561323000},"source":"Crossref","is-referenced-by-count":0,"title":["Acute Respiratory Failure and Ventilatory Support in Hospitalized Adults With Viral Respiratory Infection: A Retrospective Cohort Study"],"prefix":"10.1093","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-2513-0871","authenticated-orcid":false,"given":"Kirill","family":"Neumann","sequence":"first","affiliation":[{"name":"Pulmonary Department, Akershus University Hospital , Nordbyhagen ,","place":["Norway"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-0654-6897","authenticated-orcid":false,"given":"Magrit","family":"Jarlsdatter Hovind","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Akershus University Hospital , Nordbyhagen ,","place":["Norway"]},{"name":"Institute for Clinical Medicine, Faculty of Medicine, University of Oslo , Oslo ,","place":["Norway"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7299-6199","authenticated-orcid":false,"given":"Jan-Erik","family":"Berdal","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Akershus University Hospital , Nordbyhagen ,","place":["Norway"]},{"name":"Institute for Clinical Medicine, Faculty of Medicine, University of Oslo , Oslo ,","place":["Norway"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4470-3181","authenticated-orcid":false,"given":"Olav","family":"Dalgard","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Akershus University Hospital , Nordbyhagen ,","place":["Norway"]},{"name":"Institute for Clinical Medicine, Faculty of Medicine, University of Oslo , Oslo ,","place":["Norway"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5767-4992","authenticated-orcid":false,"given":"Truls Michael","family":"Leegaard","sequence":"additional","affiliation":[{"name":"Institute for Clinical Medicine, Faculty of Medicine, University of Oslo , Oslo ,","place":["Norway"]},{"name":"Department of Microbiology and Infection Control, Akershus University Hospital , Nordbyhagen ,","place":["Norway"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8068-4101","authenticated-orcid":false,"given":"William","family":"Ward Siljan","sequence":"additional","affiliation":[{"name":"Pulmonary Department, Akershus University Hospital , Nordbyhagen ,","place":["Norway"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2235-6310","authenticated-orcid":false,"given":"Gunnar","family":"Einvik","sequence":"additional","affiliation":[{"name":"Pulmonary Department, Akershus University Hospital , Nordbyhagen ,","place":["Norway"]},{"name":"Institute for Clinical Medicine, Faculty of Medicine, University of Oslo , Oslo ,","place":["Norway"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5994-9304","authenticated-orcid":false,"given":"Magnus Nakrem","family":"Lyngbakken","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Akershus University Hospital , Nordbyhagen ,","place":["Norway"]},{"name":"Institute for Clinical Medicine, Faculty of Medicine, University of Oslo , Oslo ,","place":["Norway"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,4,8]]},"reference":[{"key":"2026081907561594100_ofag189-B1","doi-asserted-by":"crossref","DOI":"10.1177\/1753466621995050","article-title":"Respiratory viral infections in the elderly","volume":"15","author":"Watson","year":"2021","journal-title":"Ther Adv Respir Dis"},{"key":"2026081907561594100_ofag189-B2","doi-asserted-by":"crossref","DOI":"10.1111\/irv.13275","article-title":"Assessment of illness severity in adults hospitalized with acute respiratory tract infection due to influenza, respiratory syncytial virus, or human metapneumovirus","volume":"18","author":"Falsey","year":"2024","journal-title":"Influenza Other Respir Viruses"},{"key":"2026081907561594100_ofag189-B3","doi-asserted-by":"crossref","first-page":"489","DOI":"10.1016\/j.ijid.2020.11.185","article-title":"Morbidity and mortality of respiratory syncytial virus infection in hospitalized adults: comparison with seasonal influenza","volume":"103","author":"Atamna","year":"2021","journal-title":"Int J Infect Dis"},{"key":"2026081907561594100_ofag189-B4","doi-asserted-by":"crossref","first-page":"1917","DOI":"10.1007\/s40121-025-01187-2","article-title":"The burden of human metapneumovirus (hMPV) disease in older and high-risk adults in developed countries: a systematic literature review","volume":"14","author":"Sobanjo-Ter Meulen","year":"2025","journal-title":"Infect Dis Ther"},{"key":"2026081907561594100_ofag189-B5","doi-asserted-by":"crossref","first-page":"1298","DOI":"10.1093\/infdis\/jiaa361","article-title":"Severe morbidity and short- and mid- to long-term mortality in older adults hospitalized with respiratory syncytial virus infection","volume":"222","author":"Tseng","year":"2020","journal-title":"J Infect Dis"},{"key":"2026081907561594100_ofag189-B6","doi-asserted-by":"crossref","first-page":"S19","DOI":"10.1093\/infdis\/jiaf266","article-title":"Human metapneumovirus, respiratory syncytial virus and influenza associated pneumonia hospitalizations in Colorado adults aged over 50 years: 2016-2023","volume":"232","author":"Simoes","year":"2025","journal-title":"J Infect Dis"},{"key":"2026081907561594100_ofag189-B7","doi-asserted-by":"crossref","DOI":"10.1093\/ofid\/ofaf373","article-title":"Incidence of human metapneumovirus among older adults in 10 high-income countries: a systematic literature review, meta-analysis, and modeling study","volume":"12","author":"Lei","year":"2025","journal-title":"Open Forum Infect Dis"},{"key":"2026081907561594100_ofag189-B8","doi-asserted-by":"crossref","DOI":"10.1001\/jamanetworkopen.2024.4954","article-title":"Severity of respiratory syncytial virus vs COVID-19 and influenza among hospitalized US adults","volume":"7","author":"Surie","year":"2024","journal-title":"JAMA Netw Open"},{"key":"2026081907561594100_ofag189-B9","doi-asserted-by":"crossref","first-page":"6690","DOI":"10.1038\/s41598-024-55378-x","article-title":"Comparison of mortality and outcomes of four respiratory viruses in the intensive care unit: a multicenter retrospective study","volume":"14","author":"Grangier","year":"2024","journal-title":"Sci Rep"},{"key":"2026081907561594100_ofag189-B10","doi-asserted-by":"crossref","first-page":"e403","DOI":"10.1002\/hsr2.403","article-title":"Etiology of viral respiratory tract infections in hospitalized adults, and evidence of the high frequency of prehospitalization antibiotic treatment in Norway","volume":"4","author":"Debes","year":"2021","journal-title":"Health Sci Rep"},{"key":"2026081907561594100_ofag189-B11","doi-asserted-by":"crossref","first-page":"473","DOI":"10.1111\/apm.12375","article-title":"Comparison of nasopharyngeal aspirate with flocked swab for PCR-detection of respiratory viruses in children","volume":"123","author":"Tunsj\u00f8","year":"2015","journal-title":"Apmis"},{"key":"2026081907561594100_ofag189-B12","doi-asserted-by":"crossref","first-page":"169","DOI":"10.1183\/09031936.00172113","article-title":"Prolonged shedding of rhinovirus and re-infection in adults with respiratory tract illness","volume":"44","author":"Zlateva","year":"2014","journal-title":"Eur Respir J"},{"key":"2026081907561594100_ofag189-B13","doi-asserted-by":"crossref","DOI":"10.2807\/1560-7917.ES.2020.25.3.2000045","article-title":"Detection of 2019 novel coronavirus (2019-nCoV) by real-time RT-PCR","volume":"25","author":"Corman","year":"2020","journal-title":"Euro Surveill"},{"key":"2026081907561594100_ofag189-B14","doi-asserted-by":"crossref","first-page":"1980","DOI":"10.1093\/cid\/ciad031","article-title":"Prevalence and clinical outcomes of respiratory syncytial virus vs influenza in adults hospitalized with acute respiratory illness from a prospective multicenter study","volume":"76","author":"Begley","year":"2023","journal-title":"Clin Infect Dis"},{"key":"2026081907561594100_ofag189-B15","article-title":"Clinical outcome of viral respiratory tract infections in hospitalized adults in Norway: high degree of inflammation and need of emergency care for cases with respiratory syncytial virus","volume":"9","author":"Debes","year":"2022","journal-title":"Front Med (Lausanne)"},{"key":"2026081907561594100_ofag189-B16","doi-asserted-by":"crossref","first-page":"S1","DOI":"10.1093\/infdis\/jiaf187","article-title":"Review: knowledge gained and gaps in understanding in the 25 years since human metapneumovirus was first identified as a cause of human disease","volume":"232","author":"Branche","year":"2025","journal-title":"J Infect Dis"},{"key":"2026081907561594100_ofag189-B17","article-title":"Risk factors and medical resource utilization of respiratory syncytial virus, human metapneumovirus, and influenza-related hospitalizations in adults-A global study during the 2017-2019 epidemic seasons (Hospitalized Acute Respiratory Tract Infection [HARTI] study)","volume":"8","author":"Falsey","year":"2021","journal-title":"Open Forum Infect Dis"},{"key":"2026081907561594100_ofag189-B18","doi-asserted-by":"crossref","first-page":"56","DOI":"10.1093\/infdis\/jis309","article-title":"Rates of hospitalizations for respiratory syncytial virus, human metapneumovirus, and influenza virus in older adults","volume":"206","author":"Widmer","year":"2012","journal-title":"J Infect Dis"},{"key":"2026081907561594100_ofag189-B19","doi-asserted-by":"crossref","DOI":"10.1016\/j.ijid.2025.108006","article-title":"The silent surge: the under-recognised burden of respiratory syncytial virus, human metapneumovirus, and parainfluenza viruses in adults","volume":"159","author":"Davido","year":"2025","journal-title":"Int J Infect Dis"},{"key":"2026081907561594100_ofag189-B20","doi-asserted-by":"crossref","first-page":"101","DOI":"10.1186\/s13613-023-01196-9","article-title":"Prognosis of critically ill immunocompromised patients with virus-detected acute respiratory failure","volume":"13","author":"Dumas","year":"2023","journal-title":"Ann Intensive Care"},{"key":"2026081907561594100_ofag189-B21","doi-asserted-by":"crossref","first-page":"518","DOI":"10.1164\/rccm.201804-0681OC","article-title":"Clinical significance of upper airway virus detection in critically ill hematology patients","volume":"199","author":"Legoff","year":"2019","journal-title":"Am J Respir Crit Care Med"},{"key":"2026081907561594100_ofag189-B22","doi-asserted-by":"crossref","first-page":"1061","DOI":"10.1086\/432732","article-title":"A prospective study comparing human metapneumovirus with other respiratory viruses in adults with hematologic malignancies and respiratory tract infections","volume":"192","author":"Williams","year":"2005","journal-title":"J Infect Dis"},{"key":"2026081907561594100_ofag189-B23","doi-asserted-by":"crossref","first-page":"261","DOI":"10.1016\/j.redar.2020.03.006","article-title":"Clinical consensus recommendations regarding non-invasive respiratory support in the adult patient with acute respiratory failure secondary to SARS-CoV-2 infection","volume":"67","author":"Cinesi G\u00f3mez","year":"2020","journal-title":"Rev Esp Anestesiol Reanim (Engl Ed)"},{"key":"2026081907561594100_ofag189-B24","doi-asserted-by":"crossref","DOI":"10.1016\/j.jcv.2025.105775","article-title":"Comparison of patients presenting to emergency departments infected with respiratory syncytial virus versus influenza virus: a retrospective cohort study","volume":"177","author":"Alame","year":"2025","journal-title":"J Clin Virol"},{"key":"2026081907561594100_ofag189-B25","doi-asserted-by":"crossref","DOI":"10.1093\/ofid\/ofae513","article-title":"Clinical manifestations and outcomes in adults hospitalized with respiratory syncytial virus and influenza a\/B: a multicenter observational cohort study","volume":"11","author":"Clausen","year":"2024","journal-title":"Open Forum Infect Dis"},{"key":"2026081907561594100_ofag189-B26","doi-asserted-by":"crossref","first-page":"366","DOI":"10.1080\/23744235.2025.2450590","article-title":"Severity and outcomes of adult respiratory syncytial virus inpatient compared with influenza: observational study from Japan","volume":"57","author":"Inoue","year":"2025","journal-title":"Infect Dis (Lond)"},{"key":"2026081907561594100_ofag189-B27","doi-asserted-by":"crossref","first-page":"1239","DOI":"10.1016\/j.vaccine.2023.01.013","article-title":"Social and demographic patterns of influenza vaccination coverage in Norway, influenza seasons 2014\/15 to 2020\/21","volume":"41","author":"Kl\u00fcwer","year":"2023","journal-title":"Vaccine"},{"key":"2026081907561594100_ofag189-B28","doi-asserted-by":"crossref","DOI":"10.1016\/j.vaccine.2025.127386","article-title":"Low and inequitable influenza and COVID-19 vaccination coverage among pregnant women in Norway: nationwide population-based cohort study","volume":"61","author":"Hansen","year":"2025","journal-title":"Vaccine"},{"key":"2026081907561594100_ofag189-B29","doi-asserted-by":"crossref","first-page":"944","DOI":"10.3390\/v15040944","article-title":"Evolution of SARS-CoV-2 variants: implications on immune Escape, vaccination, therapeutic and diagnostic strategies","volume":"15","author":"Zabidi","year":"2023","journal-title":"Viruses"},{"key":"2026081907561594100_ofag189-B30","doi-asserted-by":"crossref","first-page":"1457","DOI":"10.1186\/s12879-025-11904-4","article-title":"Comparison of fully-vaccinated and non\/partially-vaccinated critically-ill COVID-19 patients in terms of disease severity: a retrospective observational study","volume":"25","author":"Louis","year":"2025","journal-title":"BMC Infect Dis"},{"key":"2026081907561594100_ofag189-B31","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pmed.1003501","article-title":"Comparative efficacy and safety of pharmacological interventions for the treatment of COVID-19: a systematic review and network meta-analysis","volume":"17","author":"Kim","year":"2020","journal-title":"PLoS Med"}],"container-title":["Open Forum Infectious Diseases"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ofid\/advance-article-pdf\/doi\/10.1093\/ofid\/ofag189\/67937451\/ofag189.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ofid\/article-pdf\/13\/4\/ofag189\/68099217\/ofag189.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ofid\/article-pdf\/13\/4\/ofag189\/68099217\/ofag189.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T11:56:29Z","timestamp":1787140589000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ofid\/article\/doi\/10.1093\/ofid\/ofag189\/8627019"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,30]]},"references-count":31,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2026,3,30]]}},"URL":"https:\/\/doi.org\/10.1093\/ofid\/ofag189","relation":{},"ISSN":["2328-8957"],"issn-type":[{"value":"2328-8957","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,4]]},"published":{"date-parts":[[2026,3,30]]},"article-number":"ofag189"}}