LABORATORY MARKERS AND SHORT-TERM OUTCOMES IN RESPIRATORY SYNCYTIAL VIRUS AMONG OLDER ADULTS: MEDICARE-ENHANCED AND LABORATORY DATA ANALYSIS 2021-2025
Author(s)
Onur Baser, MA, MS, PhD1, Nehir Yapar, BS2, Shuangrui Chen, MS2, Wanlin Guo, MS2;
1City University of New York (CUNY), New York, NY, USA, 2Columbia Data Analytics, New York, NY, USA
1City University of New York (CUNY), New York, NY, USA, 2Columbia Data Analytics, New York, NY, USA
OBJECTIVES: Describe clinical and laboratory profile and short‑term outcomes of respiratory syncytial virus (RSV) among Medicare fee‑for‑service (FFS) beneficiaries ≥65 years
METHODS: A retrospective cohort of Medicare FFS beneficiaries aged ≥65 years with laboratory‑confirmed RSV 2021-2025 was identified from Medicare-Enhanced Labs and Demographics (MELDTM) data (100% Medicare claims deterministically linked to laboratory and EMR). RSV cases were defined by a positive RSV PCR or multiplex respiratory panel result plus RSV diagnosis code during ED or inpatient encounter (index date=first positive RSV test date). Baseline variables: Demographics, comorbidities, laboratory tests −24 to +48 hours of index date: CBC, C‑reactive protein (CRP), procalcitonin, creatinine, liver function tests, albumin, troponin, brain natriuretic peptide (BNP)/ (N-terminal prohormone of BNP (NT‑proBNP). Outcomes: 30‑day all‑cause mortality, ICU, high‑flow oxygen/mechanical ventilation. Multivariable models examined associations between baseline laboratory abnormalities and 30‑day outcomes, adjusting for age, sex, and comorbidities.
RESULTS: After applying eligibility criteria, 85,000 RSV‑positive Medicare FFS beneficiaries were included; mean age:78 years; female:56%. At baseline, 28% had COPD, 32% heart failure, and 38% diabetes. Common laboratory abnormalities: Lymphopenia (≈45%), elevated CRP (>50mg/L in ≈40%), elevated procalcitonin (≥0.5ng/mL in ≈25%). Cardiac biomarkers were frequently abnormal: high‑sensitivity troponin was above the upper reference limit in ≈30%; BNP/NT‑proBNP was elevated in ≈40% of patients. Hypoalbuminemia (<3.5g/dL) was present in ≈35%. Adjusted analyses showed elevated CRP, lymphopenia, elevated troponin. Elevated BNP/NT‑proBNP were independently associated with higher odds of 30‑day mortality and ICU admission. Patients with elevated troponin+BNP/NT‑proBNP had ~2‑fold higher adjusted risk of 30‑day mortality vs normal cardiac biomarkers.
CONCLUSIONS: Linked Medicare claims+EMR enabled granular characterization of laboratory markers of disease severity for individuals diagnosed with RSV. Abnormal inflammatory (CRP, procalcitonin), hematologic (lymphopenia), and cardiac (troponin, BNP/NT‑proBNP) tests were common and associated with worse 30‑day outcomes, underscoring the importance of integrating laboratory‑based risk stratification into real‑world RSV management and economic evaluations in the elderly.
METHODS: A retrospective cohort of Medicare FFS beneficiaries aged ≥65 years with laboratory‑confirmed RSV 2021-2025 was identified from Medicare-Enhanced Labs and Demographics (MELDTM) data (100% Medicare claims deterministically linked to laboratory and EMR). RSV cases were defined by a positive RSV PCR or multiplex respiratory panel result plus RSV diagnosis code during ED or inpatient encounter (index date=first positive RSV test date). Baseline variables: Demographics, comorbidities, laboratory tests −24 to +48 hours of index date: CBC, C‑reactive protein (CRP), procalcitonin, creatinine, liver function tests, albumin, troponin, brain natriuretic peptide (BNP)/ (N-terminal prohormone of BNP (NT‑proBNP). Outcomes: 30‑day all‑cause mortality, ICU, high‑flow oxygen/mechanical ventilation. Multivariable models examined associations between baseline laboratory abnormalities and 30‑day outcomes, adjusting for age, sex, and comorbidities.
RESULTS: After applying eligibility criteria, 85,000 RSV‑positive Medicare FFS beneficiaries were included; mean age:78 years; female:56%. At baseline, 28% had COPD, 32% heart failure, and 38% diabetes. Common laboratory abnormalities: Lymphopenia (≈45%), elevated CRP (>50mg/L in ≈40%), elevated procalcitonin (≥0.5ng/mL in ≈25%). Cardiac biomarkers were frequently abnormal: high‑sensitivity troponin was above the upper reference limit in ≈30%; BNP/NT‑proBNP was elevated in ≈40% of patients. Hypoalbuminemia (<3.5g/dL) was present in ≈35%. Adjusted analyses showed elevated CRP, lymphopenia, elevated troponin. Elevated BNP/NT‑proBNP were independently associated with higher odds of 30‑day mortality and ICU admission. Patients with elevated troponin+BNP/NT‑proBNP had ~2‑fold higher adjusted risk of 30‑day mortality vs normal cardiac biomarkers.
CONCLUSIONS: Linked Medicare claims+EMR enabled granular characterization of laboratory markers of disease severity for individuals diagnosed with RSV. Abnormal inflammatory (CRP, procalcitonin), hematologic (lymphopenia), and cardiac (troponin, BNP/NT‑proBNP) tests were common and associated with worse 30‑day outcomes, underscoring the importance of integrating laboratory‑based risk stratification into real‑world RSV management and economic evaluations in the elderly.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
CO153
Topic
Clinical Outcomes
Disease
SDC: Respiratory-Related Disorders (Allergy, Asthma, Smoking, Other Respiratory), STA: Vaccines