Clinical Characteristics, Management and Prognostic Factors in Patients with Probable Severe Acute Respiratory Syndrome (SARS) in a SARS Center in Taiwan : Journal of the Chinese Medical Association

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Clinical Characteristics, Management and Prognostic Factors in Patients with Probable Severe Acute Respiratory Syndrome (SARS) in a SARS Center in Taiwan

Liu, Chun-Yua; Huang, Lin-Jub; Lai, Chung-Hsub; Chen, Hsin-Paib; Chen, Te-Lib, c, *; Fung, Chang-Phoneb, c; Li, Cheng-Yib, c

Author Information

aDepartment of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C.

bSection of Infectious Diseases, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C.

cNational Yang-Ming University School of Medicine, Taipei, Taiwan, R.O.C.

*Correspondence to: Dr. Te-Li Chen, Section of Infectious Diseases, Department of Medicine, Taipei Veterans General Hospital, 201, Section 2, Shih-Pai Road, Taipei 112, Taiwan, R.O.C.

E-mail: [email protected]

Received: November 26, 2003 • Accepted: July 21, 2004

Journal of the Chinese Medical Association 68(3):p 110-117, March 2005. | DOI: 10.1016/S1726-4901(09)70231-X

    Abstract

    Background: 

    Severe acute respiratory syndrome (SARS) is an emerging viral infectious disease. We report our experience in treating SARS patients.

    Methods: 

    From April 27 to May 24, 2003, a total of 36 patients with probable SARS were admitted and treated in a hospital rearranged as a special center for the management of SARS patients. Medical records for the patients were retrospectively reviewed. Univariate and multivariate analyses were performed to determine factors associated with respiratory failure and intubation.

    Results: 

    Of the 36 patients with probable SARS (median age, 37 years; range, 22-66 years), 9 were male and 27 were female. Thirty-two patients (88.9%) were infected in the hospital setting. All patients presented with fever, and 33 eventually developed lymphopenia during hospitalization. Chest radiography showed no unique pattern, but pleural effusion was not seen. All patients initially received empiric antibacterial therapy against common causative pathogens of atypical pneumonia. Ribavirin was given to all except 1 patient. Twenty-two patients received immunoglobulin therapy, and 32 were given corticosteroids. A total of 20 patients (55.6%) required supplemental oxygen, and 8 (22.2%) were intubated with mechanical ventilatory support. Two of these patients died. A higher body temperature at presentation (median 39.5 vs 38.6°C), and higher peak values of lactate dehydrogenase (410 vs 282 U/L) and C-reactive protein (10.2 vs 2.5 mg/dL), were associated with subsequent respiratory failure. Multivariate analysis showed that peak level of C-reactive protein was the only independent predictor of respiratory failure and intubation (odds ratio for every increment of 1 mg/dL = 1.45; 95% confidence interval = 1.003, 2.097; p = 0.048).

    Conclusion: 

    All patients with probable SARS who were admitted to hospital presented with fever and lymphopenia. While the efficacy of different treatments could not be evaluated from this retrospective study, a higher value of C-reactive protein was associated with the development of respiratory failure and subsequent intubation.

    © 2005 by Lippincott Williams & Wilkins, Inc.