SARS-CoV-2 dramatically revealed the sudden impact of respiratory viruses in our lives. Influenza and respiratory syncytial virus (RSV) infections are associated with high rates of morbidity, mortality, and an important burden on healthcare systems worldwide, especially in elderly patients. The aim of this study was to identify severity predictors in the oldest-old admitted with influenza and/or RSV infections. This is a multicenter, retrospective study of all oldest-old patients (≥ 85 years old) admitted for laboratory-confirmed influenza and/or RSV infection in three tertiary hospitals in Portugal, Italy, and Cyprus over two consecutive winter seasons. The outcomes included the following: pneumonia on infection presentation, use of non-invasive ventilation (NIV), and in-hospital death (IHD). The association with possible predictors, including clinical features and type of virus infection, was assessed using uni- and multivariable analyses. A total of 251 oldest-old patients were included in the study. Pneumonia was evident in 32.3% (n = 81). NIV was implemented in 8.8% (n = 22), and IHD occurred in 13.9% (n = 35). Multivariable analyses revealed that chronic obstructive pulmonary disease (COPD) or asthma was associated with pneumonia (OR 1.86; 95% CI 1.02–3.43; p = 0.045). COPD or asthma (OR 4.4; 95% CI 1.67–11.6; p = 0.003), RSV (OR 3.12; 95% CI 1.09–8.92; p = 0.023), and influenza B infections (OR 3.77; 95% CI 1.06–13.5; p = 0.041) were associated with NIV use, respectively, while chronic kidney disease was associated with IHD (OR 2.50; 95% CI 1.14–5.51; p = 0.023). Among the oldest-old, chronic organ failure, such as COPD or asthma, and CKD predicted pneumonia and IHD, respectively, beyond the importance of viral virulence itself. These findings could impact on public health policies, such as fostering influenza immunization campaigns, home-based care programs, and end-of-life care. Filling knowledge gaps is crucial to set priorities and advise on transition model of care that best fits the oldest-old.

SARS-CoV-2极大地揭示了呼吸道病毒对我们生活的突然影响。流行性感冒和呼吸道合胞病毒（RSV）感染与高发病率，高死亡率以及全世界医疗保健系统（尤其是老年患者）的重要负担有关。这项研究的目的是确定最严重的流感和/或RSV感染入院者的严重程度预测指标。这是一项多中心回顾性研究，研究了连续两个冬季在葡萄牙，意大利和塞浦路斯的三家三级医院接受实验室确诊的流感和/或RSV感染的所有最老患者（≥85岁）。结果包括：感染引起的肺炎，使用无创通气（NIV）和院内死亡（IHD）。与可能的预测因素的关联，使用单变量和多变量分析评估包括临床特征和病毒感染类型。该研究总共包括251名最老的患者。肺炎的发生率为32.3％（n  = 81）。NIV实施率为8.8％（n  = 22），IHD发生率为13.9％（n  = 35）。多变量分析显示，慢性阻塞性肺疾病（COPD）或哮喘与肺炎相关（OR 1.86； 95％CI 1.02–3.43；p  = 0.045）。COPD或哮喘（OR 4.4; 95％CI 1.67-11.6; p  = 0.003），RSV（OR 3.12; 95％CI 1.09-8.92; p  = 0.023）和B型流感感染（OR 3.77; 95％CI 1.06-13.5） ；p  = 0.041）分别与NIV的使用相关，而慢性肾脏疾病与IHD相关（OR 2.50； 95％CI 1.14–5.51；p = 0.023）。在最老的慢性器官衰竭（如COPD或哮喘）中，CKD分别预测了肺炎和IHD，超出了病毒毒力本身的重要性。这些发现可能会影响公共卫生政策，例如促进流感免疫运动，家庭护理计划和临终护理。填补知识空白对于确定优先级并就最适合最老者的照护过渡模式提供建议至关重要。