Factors Associated with Mortality in Nipah Virus Infection: Diagnostic Accuracy and Therapeutic Interventions — A Systematic Review and Meta-Analysis

Nipah virus infection is a high-consequence zoonotic disease associated with recurrent outbreaks and substantial mortality in South and Southeast Asia. We conducted a systematic review and meta-analysis to evaluate laboratory predictors of mortality, diagnostic performance of commonly used tests, and associations between therapeutic interventions and survival. PubMed/MEDLINE, Embase, Scopus, Web of Science, and Cochrane Central were searched from inception to December 2025. Studies reporting laboratory-confirmed Nipah virus infection with mortality outcomes were included. Random-effects models were used to calculate pooled odds ratios (OR), mean differences (MD), sensitivity, specificity, and diagnostic odds ratios.

Twenty-five studies comprising 1,172 laboratory-confirmed cases were included. The pooled mortality rate was 58.6% (95% CI 52.4–64.7; I²=72%). Elevated aspartate aminotransferase (MD 84.5 U/L, 95% CI 51.2–117.8), alanine aminotransferase (MD 67.3 U/L, 39.8–94.7), thrombocytopenia (OR 2.94, 1.89–4.56), leukocytosis (OR 2.21, 1.43–3.42), and increased cerebrospinal fluid protein (MD 32.7 mg/dL, 14.1–51.3) were associated with mortality. Reverse transcription polymerase chain reaction demonstrated pooled sensitivity of 91.3% (86.7–94.4) and specificity of 97.8% (94.9–99.1), with area under the summary receiver operating characteristic curve of 0.97. Ribavirin was not associated with reduced mortality (OR 0.88, 0.62–1.26). Mechanical ventilation was associated with mortality (OR 4.73, 3.01–7.42), whereas early intensive care admission was associated with reduced mortality (OR 0.72, 0.54–0.96). Mortality remains high, underscoring the need for early risk stratification, rapid molecular diagnosis, and improved supportive care pathways.