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Background Chest radiographic consolidation is a marker of severe viral infection and a key factor in hospital management. Rates of consolidation and risk factors across RVI in adults remain poorly defined.Objectives To identify prevalence and clinical and laboratory predictors of consolidation in adults with RVI in a multi-centre UK study cohortMethods Analysis of the UNIVERSAL UK multicentre cohort of adults hospitalised with PCR-confirmed RVI. Admission chest radiographs were reviewed by clinical radiology staff and binarised for consolidation. Univariable and multivariable logistic regression were used to identify predictors.Results Between August 2022 and May 2025, 533 patients with RVI had chest radiography data. Consolidation was reported in 157/533 (29%) and was evenly distributed across viral groups (p = 0.170). Proportion with consolidation by viral group: influenza 32 (20%), SARS-CoV-2 52 (33%), RSV 21 (13%), rhino/enterovirus 29 (18%) and other viruses (Human metapneumovirus, coronaviruses, adenovirus and parainfluenza) 23 (15%).Median age was 70 (IQR 58–76) with consolidation versus 65 (IQR 53–76) without, p = 0.043. Consolidation was more common males 88/157 (56%) versus 161/376 (43%), p = 0.006 and in those vaccinated against pneumococcus 82/153 (54%) versus 144/370 (39%), p = 0.002.Consolidation was associated with ICU admission 10/156 (6.4%) versus 0/376 (0%), p < 0.001, oxygen requirement on admission 109/157 (69%) versus 205/375 (55%), p = 0.001, longer hospital stay (median 5 versus 4 days, p <0.001), and 60-day mortality 10/153 (6.5%) versus 8/365 (2.2%), p = 0.014. Median Charlson co-morbidity index was 9 (IQR 6–15) with consolidation versus 7 (IQR 4–12) without, p = 0.359.Median CRP and neutrophil-to-lymphocyte ratio (NLR) were higher with consolidation, CRP 113 versus 33 mg/L, NLR 9 versus 7, both p < 0.001.Multivariable analysis identified pneumococcal vaccination (OR 1.89, 95% CI 1.20–3.00, p = 0.006) and CRP >50 mg/L (OR 4.64, 95% CI 2.30–10.10, p < 0.001) as predictors of consolidation.Only 47/157 (30%) with consolidation had pneumonia listed as primary diagnosis on discharge (kappa = 0.265).Abstract P182 Table 1Characteristics of patients based on presence or absence of consolidation on chest radiographConclusion Consolidation was seen across RVIs and linked to inflammation and poor outcomes. Concordance with discharge diagnoses was limited, with possible implications for health economics.