Molecular Etiology and Mortality Risk Stratification of Non-SARS-CoV-2 Severe Acute Respiratory Infection in a Predominantly Pediatric Cohort: A Retrospective Study From a Tertiary Care Hospital in North India.

backgroundSevere acute respiratory infections (SARI) remain a major cause of hospitalization and mortality, particularly among children and other vulnerable populations. Early identification of pathogens and disease severity is essential for clinical decision-making. This study evaluated the etiology of non-SARS-CoV-2 SARI and the prognostic utility of the ViVI Disease Severity Score (ViVI Score) in a predominantly pediatric cohort.

methodsIn this retrospective study, 117 hospitalized SARS-CoV-2-negative SARI patients, including 103 children and 14 adults, admitted to a tertiary care hospital in North India between September and December 2021 were evaluated. Respiratory pathogens were identified using multiplex polymerase chain reaction (PCR), alongside blood and lower respiratory tract cultures. Serum C-reactive protein (CRP), procalcitonin (PCT), and D-dimer were measured. Mortality prediction was assessed using the ViVI Score and receiver operating characteristic (ROC) curve analysis.

resultsThe median age was 2.0 years (interquartile range, 0.5-7.5 years). Multiplex PCR detected respiratory pathogens in 69.2% of patients, with human respiratory syncytial virus (HRSV) A/B predominating. Blood cultures were positive in 40/117 patients (34.2%), predominantly yielding methicillin-sensitive

conclusionHRSV was the predominant respiratory pathogen, whereas bacterial sepsis was the principal determinant of mortality. Multiplex molecular diagnostics combined with standardized severity assessment may improve clinical triage, antimicrobial stewardship, and respiratory pathogen surveillance in resource-limited settings.