Severe acute respiratory syndrome : report of treatment and outcome after a major outbreak
BACKGROUND: The outcome is reported of a prospective uncontrolled study based on a stepwise treatment protocol during an outbreak of severe acute respiratory syndrome (SARS) in Hong Kong.
METHOD: One hundred and thirty eight patients were treated with broad spectrum antibiotics, a combination of ribavirin and low dose corticosteroid, and then intravenous high dose methylprednisolone according to responses. Sustained response to treatment was defined as (1) defervescence for > or =4 consecutive days, (2) resolution of lung consolidation by >25%, and (3) oxygen independence by the fourth day without fever. Patients with defervescence who achieved either criterion 2 or 3 were classified as partial responders. Patients who fell short of criteria 2 and 3 were non-responders.
RESULTS: Laboratory confirmation of SARS coronavirus infection was established in 132 (95.7%). None responded to antibiotics but 25 (18.1%) responded to ribavirin + low dose corticosteroid. Methylprednisolone was used in 107 patients, of whom 95 (88.8%) responded favourably. Evidence of haemolytic anaemia was observed in 49 (36%). A high level of C-reactive protein at presentation was the only independent predictor for use of methylprednisolone (odds ratio 2.18 per 10 mg/dl increase, 95% confidence interval 1.12 to 4.25, p = 0.02). Thirty seven patients (26.8%) required admission to the intensive care unit and 21 (15.2%) required invasive mechanical ventilation. There were 15 deaths (mortality rate 10.9%), most with significant co-morbidities, whereas 122 (88.4%) had been discharged home 4 months after the outbreak onset.
CONCLUSION: The use of high dose pulse methylprednisolone during the clinical course of a SARS outbreak was associated with clinical improvement, but randomised controlled trials are needed to ascertain its efficacy in this condition.
| Medienart: |
Artikel |
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| Erscheinungsjahr: |
2004 |
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| Erschienen: |
2004 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:59 |
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| Enthalten in: |
Thorax - 59(2004), 5 vom: 28. Mai, Seite 414-20 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Sung, J J Y [VerfasserIn] |
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| Themen: |
Anti-Infective Agents |
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| Anmerkungen: |
Date Completed 24.05.2004 Date Revised 08.12.2020 published: Print Citation Status MEDLINE |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM148075053 |
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| 100 | 1 | |a Sung, J J Y |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Severe acute respiratory syndrome |b report of treatment and outcome after a major outbreak |
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| 500 | |a Date Completed 24.05.2004 | ||
| 500 | |a Date Revised 08.12.2020 | ||
| 500 | |a published: Print | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a BACKGROUND: The outcome is reported of a prospective uncontrolled study based on a stepwise treatment protocol during an outbreak of severe acute respiratory syndrome (SARS) in Hong Kong | ||
| 520 | |a METHOD: One hundred and thirty eight patients were treated with broad spectrum antibiotics, a combination of ribavirin and low dose corticosteroid, and then intravenous high dose methylprednisolone according to responses. Sustained response to treatment was defined as (1) defervescence for > or =4 consecutive days, (2) resolution of lung consolidation by >25%, and (3) oxygen independence by the fourth day without fever. Patients with defervescence who achieved either criterion 2 or 3 were classified as partial responders. Patients who fell short of criteria 2 and 3 were non-responders | ||
| 520 | |a RESULTS: Laboratory confirmation of SARS coronavirus infection was established in 132 (95.7%). None responded to antibiotics but 25 (18.1%) responded to ribavirin + low dose corticosteroid. Methylprednisolone was used in 107 patients, of whom 95 (88.8%) responded favourably. Evidence of haemolytic anaemia was observed in 49 (36%). A high level of C-reactive protein at presentation was the only independent predictor for use of methylprednisolone (odds ratio 2.18 per 10 mg/dl increase, 95% confidence interval 1.12 to 4.25, p = 0.02). Thirty seven patients (26.8%) required admission to the intensive care unit and 21 (15.2%) required invasive mechanical ventilation. There were 15 deaths (mortality rate 10.9%), most with significant co-morbidities, whereas 122 (88.4%) had been discharged home 4 months after the outbreak onset | ||
| 520 | |a CONCLUSION: The use of high dose pulse methylprednisolone during the clinical course of a SARS outbreak was associated with clinical improvement, but randomised controlled trials are needed to ascertain its efficacy in this condition | ||
| 650 | 4 | |a Journal Article | |
| 650 | 7 | |a Anti-Infective Agents |2 NLM | |
| 650 | 7 | |a Glucocorticoids |2 NLM | |
| 650 | 7 | |a Methylprednisolone |2 NLM | |
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| 700 | 1 | |a Wu, A |e verfasserin |4 aut | |
| 700 | 1 | |a Joynt, G M |e verfasserin |4 aut | |
| 700 | 1 | |a Yuen, K Y |e verfasserin |4 aut | |
| 700 | 1 | |a Lee, N |e verfasserin |4 aut | |
| 700 | 1 | |a Chan, P K S |e verfasserin |4 aut | |
| 700 | 1 | |a Cockram, C S |e verfasserin |4 aut | |
| 700 | 1 | |a Ahuja, A T |e verfasserin |4 aut | |
| 700 | 1 | |a Yu, L M |e verfasserin |4 aut | |
| 700 | 1 | |a Wong, V W |e verfasserin |4 aut | |
| 700 | 1 | |a Hui, D S C |e verfasserin |4 aut | |
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