Clinical characteristics, risk factors and outcomes of Human metapneumovirus infection: A 2022–2024 retrospective study in Bangladesh

• Increasing trend of hMPV cases from 2022 (26.9%) to 2024 (37.2%) • Cough (69.2%), fever (65.4%), dyspnoea (37.2%) was the most common symptoms. • Higher hospitalization risk noted in extreme age groups (<18 years and > 50 years) • Lymphopenia, high CRP, radiological chest abnormalities predictors of hospitalization. • Only adult had ICU admission (20.5%) and mortality (3.8%) Human metapneumovirus (hMPV) causes a significant proportion of acute respiratory tract infections, particularly in elderly patients and young children. Although clinical recognition is growing in Bangladesh, epidemiology, risk factors, and outcomes have incomplete data. In this study we aimed to assess clinical characteristics, risk factors and outcomes of hMPV infection in a tertiary care facility situated at Dhaka, Bangladesh from 2022 to 2024. This retrospective observational study was conducted at the Evercare Hospital, Dhaka. 78 RT-PCR confirmed HMPV subjects had their medical records reviewed. Hospitalization status, demographics, clinical presentation, laboratory data complications, outcomes were extracted. Independent predictors were identified using multivariate logistic regression. 78 patients who were diagnosed with hMPV infection between 2022 and 2024 with male slightly higher 44 (56.4 %) and mean age 42.8 (24.1) years. Of the 78 patients, 41 (52.6 %) were treated as outpatients, whereas 37 (47.2 %) in patients. Cough (69.2 %) and fever (65.4 %) were the most common symptoms, and hospitalization was substantially correlated with dyspnea (p < 0.001). 50 % of patients had comorbidities, with the most prevalent being hypertension (21.8 %). 47.4 % of cases required hospitalization, 20.5 % required intensive care unit admission, and 3.8 % resulted in death (all adults). Multivariate analysis revealed elevated C-reactive protein (OR = 5.41p 0.021), radiological chest abnormalities (OR = 6.51, p 0.014), lymphopenia (OR = 23.2, p 0.048), and age extremes (<18 years: OR = 12.7, p 0.011; >50 years: OR = 6.31, p 0.041) were associated with hospitalization. HMPV infection represents a significant illness burden in children and elderly populations due to high hospitalization rates and serious consequences. Key predictors of hospitalization consist of lymphopenia, high CRP and abnormalities on chest imaging highlighting the significance of early risk stratification and of targeted surveillance.