Temporal trends in critical care burden and outcomes of Andes virus-associated hantavirus cardiopulmonary syndrome: a national Chilean cohort.

Abstract

Andes virus causes hantavirus cardiopulmonary syndrome (HCPS), a severe disease found in central and southern parts of Chile and Argentina. Recently a case-outbreak of HCPS was reported on a cruise ship, therefore contemporary data on organ support and outcomes is required. The objective of this study was to assess organ support use and patient outcomes in patients admitted with HCPS. We used the Diagnosis-Related Groups (DGR) database to analyse patients admitted in 31 Chilean hospitals between January 1, 2019, and December 31, 2024. They were stratified by the maximal respiratory support received: no respiratory support, non-invasive ventilation (NIV), invasive mechanical ventilation (MV) or extracorporeal membrane oxygenation (ECMO). Hospital length of stay (LOS) and in-hospital mortality were the main outcomes assessed. In-hospital mortality was further analysed by pre-COVID-19 pandemic, pandemic, and post-pandemic periods. A total of 215 patients with HCPS were identified, of whom 69.3% were males and 87% were adults. Of 148 patients who required respiratory support, 14.2% received NIV, 36.5% received MV and 49.3% required ECMO. Hospital LOS was 8 [3-15] days and in-hospital mortality was 20.5%. Case fatality rates were 29.6% for patients receiving MV and 32.9% for those receiving ECMO. The pandemic period was independently associated with higher in-hospital mortality (aOR 2.73 [1.06-7.63]; p = 0.045). HCPS caused by Andes virus remains associated with high in-hospital mortality and substantial amounts of respiratory support, particularly MV and ECMO. Moreover, the COVID-19 pandemic was associated with a significant increase in HCPS mortality.