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Article: Severe acute respiratory syndrome: Report of treatment and outcome after a major outbreak

TitleSevere acute respiratory syndrome: Report of treatment and outcome after a major outbreak
Authors
Issue Date2004
PublisherB M J Publishing Group. The Journal's web site is located at http://thorax.bmjjournals.com/
Citation
Thorax, 2004, v. 59 n. 5, p. 414-420 How to Cite?
AbstractBackground: 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 ≥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.
Persistent Identifierhttp://hdl.handle.net/10722/43140
ISSN
2015 Impact Factor: 8.121
2015 SCImago Journal Rankings: 3.650
PubMed Central ID
ISI Accession Number ID
References

 

DC FieldValueLanguage
dc.contributor.authorSung, JJYen_HK
dc.contributor.authorWu, Aen_HK
dc.contributor.authorJoynt, GMen_HK
dc.contributor.authorYuen, KYen_HK
dc.contributor.authorLee, Nen_HK
dc.contributor.authorChan, PKSen_HK
dc.contributor.authorCockram, CSen_HK
dc.contributor.authorAhuja, ATen_HK
dc.contributor.authorYu, LMen_HK
dc.contributor.authorWong, VWen_HK
dc.contributor.authorHui, DSCen_HK
dc.date.accessioned2007-03-23T04:39:46Z-
dc.date.available2007-03-23T04:39:46Z-
dc.date.issued2004en_HK
dc.identifier.citationThorax, 2004, v. 59 n. 5, p. 414-420en_HK
dc.identifier.issn0040-6376en_HK
dc.identifier.urihttp://hdl.handle.net/10722/43140-
dc.description.abstractBackground: 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 ≥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.en_HK
dc.format.extent339931 bytes-
dc.format.extent30720 bytes-
dc.format.mimetypeapplication/pdf-
dc.format.mimetypeapplication/msword-
dc.languageengen_HK
dc.publisherB M J Publishing Group. The Journal's web site is located at http://thorax.bmjjournals.com/en_HK
dc.relation.ispartofThoraxen_HK
dc.rightsCreative Commons: Attribution 3.0 Hong Kong License-
dc.rightsThorax. Copyright © B M J Publishing Group.en_HK
dc.subject.meshRespiratory distress syndrome, adult - epidemiology - mortality - therapyen_HK
dc.subject.meshMethylprednisolone - administration & dosageen_HK
dc.subject.meshDisease outbreaksen_HK
dc.subject.meshGlucocorticoids - administration & dosageen_HK
dc.subject.meshAnti-infective agents - therapeutic useen_HK
dc.titleSevere acute respiratory syndrome: Report of treatment and outcome after a major outbreaken_HK
dc.typeArticleen_HK
dc.identifier.openurlhttp://library.hku.hk:4550/resserv?sid=HKU:IR&issn=0040-6376&volume=59&issue=5&spage=414&epage=20&date=2004&atitle=Severe+acute+respiratory+syndrome:+report+of+treatment+and+outcome+after+a+major+outbreaken_HK
dc.identifier.emailYuen, KY:kyyuen@hkucc.hku.hken_HK
dc.identifier.authorityYuen, KY=rp00366en_HK
dc.description.naturepublished_or_final_versionen_HK
dc.identifier.doi10.1136/thx.2003.014076en_HK
dc.identifier.pmid15115870-
dc.identifier.pmcidPMC1746995-
dc.identifier.scopuseid_2-s2.0-2442581595en_HK
dc.identifier.hkuros87943-
dc.relation.referenceshttp://www.scopus.com/mlt/select.url?eid=2-s2.0-2442581595&selection=ref&src=s&origin=recordpageen_HK
dc.identifier.volume59en_HK
dc.identifier.issue5en_HK
dc.identifier.spage414en_HK
dc.identifier.epage420en_HK
dc.identifier.isiWOS:000221072800012-
dc.publisher.placeUnited Kingdomen_HK
dc.identifier.scopusauthoridSung, JJY=24473715000en_HK
dc.identifier.scopusauthoridWu, A=7402998681en_HK
dc.identifier.scopusauthoridJoynt, GM=7005588815en_HK
dc.identifier.scopusauthoridYuen, KY=36078079100en_HK
dc.identifier.scopusauthoridLee, N=7402722286en_HK
dc.identifier.scopusauthoridChan, PKS=7403497792en_HK
dc.identifier.scopusauthoridCockram, CS=7006379262en_HK
dc.identifier.scopusauthoridAhuja, AT=35449659800en_HK
dc.identifier.scopusauthoridYu, LM=7404164174en_HK
dc.identifier.scopusauthoridWong, VW=7202525502en_HK
dc.identifier.scopusauthoridHui, DSC=7101862411en_HK

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