Prognostication in Severe Acute Respiratory Syndrome: a Retrospective Time-course Analysis of 1312 Laboratory-confirmed Patients in Hong Kong

Overview

Journal Respirology

Specialty Pulmonary Medicine

Date 2007 Jun 26

PMID 17587420

Citations 26

Authors

Jane C K Chan

Eva L H Tsui

Vivian C W Wong

Affiliations

Soon will be listed here.

Abstract

Background And Objective: The temporal importance of prognostic indicators for severe acute respiratory syndrome (SARS) has not been studied. This study identified the various clinical prognostic factors for SARS and described the temporal evolution of these factors in the course of the SARS illness in Hong Kong in 2003.

Methods: A retrospective analysis of the entire Hong Kong cohort of 1312 laboratory-confirmed SARS patients aged 15-74 years was undertaken. Demographic, clinical and laboratory data at presentation and investigative data during the first 10 days of illness from the time of symptom onset were compiled. Two adverse outcomes were examined: hospital mortality and the development of oxygenation failure based on the estimated PaO(2)/FiO(2) ratio of <200 mm Hg. Logistic regression was used to identify the association between these prognostic factors and outcomes.

Results: Based on adjusted odds ratios with a P-value of <0.05, older age, male gender, elevated pulse rate and elevated neutrophil count were all predictive of oxygenation failure and death during the 10-day illness. Raised serum albumin and creatinine phosphokinase (CPK) levels were predictive of hospital mortality during this period. The presenting ALT and CPK level and the day 7 and day 10 platelet counts were predictive of oxygenation failure while the day 7 LDH was predictive of death. Contact exposure outside health-care institutions also appeared to carry higher risk of death.

Conclusion: This large-scale analysis identified important discriminatory parameters related to the patients' demographic profile (age and gender), severity of illness (pulse rate and neutrophil count), and multisystem derangement (platelet count, CPK, ALT and LDH), all of which prognosticated adverse outcomes during the SARS episode. While age, pulse rate and neutrophil count consistently remained significant prognosticators during the first 10 days of illness, the prognostic impact of other derangements was more time-course dependent. Clinicians should be aware of the time-course evolution of these prognosticators.

Citing Articles

CAPRL Scoring System for Prediction of 30-day Mortality in 949 Patients with Coronavirus Disease 2019 in Wuhan, China: A Retrospective, Observational Study.

Chen H, Yan W, Chen G, Zhang X, Zeng Z, Wang X Infect Dis Immun. 2024; 1(1):28-35.

PMID: 38630115 PMC: 8057317. DOI: 10.1097/ID9.0000000000000001.

Interpretable generalized neural additive models for mortality prediction of COVID-19 hospitalized patients in Hamadan, Iran.

Moslehi S, Mahjub H, Farhadian M, Soltanian A, Mamani M BMC Med Res Methodol. 2022; 22(1):339.

PMID: 36585627 PMC: 9803600. DOI: 10.1186/s12874-022-01827-y.

Development and Validation of an Early Scoring System for Prediction of Disease Severity in COVID-19 Using Complete Blood Count Parameters.

Rahman T, Khandakar A, Hoque M, Ibtehaz N, Kashem S, Masud R IEEE Access. 2021; 9:120422-120441.

PMID: 34786318 PMC: 8545188. DOI: 10.1109/ACCESS.2021.3105321.

Is It All About Endothelial Dysfunction and Thrombosis Formation? The Secret of COVID-19.

Elyaspour Z, Zibaeenezhad M, Razmkhah M, Razeghian-Jahromi I Clin Appl Thromb Hemost. 2021; 27:10760296211042940.

PMID: 34693754 PMC: 8543709. DOI: 10.1177/10760296211042940.

Mortality Prediction Utilizing Blood Biomarkers to Predict the Severity of COVID-19 Using Machine Learning Technique.

Rahman T, Al-Ishaq F, Al-Mohannadi F, Mubarak R, Al-Hitmi M, Islam K Diagnostics (Basel). 2021; 11(9).

PMID: 34573923 PMC: 8469072. DOI: 10.3390/diagnostics11091582.

References

Sung J, Wu A, Joynt G, Yuen K, Lee N, Chan P . Severe acute respiratory syndrome: report of treatment and outcome after a major outbreak. Thorax. 2004; 59(5):414-20. PMC: 1746995. DOI: 10.1136/thx.2003.014076. View

Yang M, Li C, Li K, Hon K, Ng M, Chan P . Hematological findings in SARS patients and possible mechanisms (review). Int J Mol Med. 2004; 14(2):311-5. View

Severinghaus J, Stafford M, Thunstrom A . Estimation of skin metabolism and blood flow with tcPO2 and tcPO2 electrodes by cuff occlusion of the circulation. Acta Anaesthesiol Scand Suppl. 1978; 68:9-15. DOI: 10.1111/j.1399-6576.1978.tb01386.x. View

Chau T, Lee P, Choi K, Lee C, Ma K, Tsang T . Value of initial chest radiographs for predicting clinical outcomes in patients with severe acute respiratory syndrome. Am J Med. 2004; 117(4):249-54. PMC: 7093886. DOI: 10.1016/j.amjmed.2004.03.020. View

Chu C, Cheng V, Hung I, Wong M, Chan K, Chan K . Role of lopinavir/ritonavir in the treatment of SARS: initial virological and clinical findings. Thorax. 2004; 59(3):252-6. PMC: 1746980. DOI: 10.1136/thorax.2003.012658. View

. Dynamic changes in blood cytokine levels as clinical indicators in severe acute respiratory syndrome. Chin Med J (Engl). 2003; 116(9):1283-7. View

Wong K, Antonio G, Hui D, Lee N, Yuen E, Wu A . Severe acute respiratory syndrome: radiographic appearances and pattern of progression in 138 patients. Radiology. 2003; 228(2):401-6. DOI: 10.1148/radiol.2282030593. View

Chan M, Wong V, Wong C, Chan P, Chu C, Hui D . Serum LD1 isoenzyme and blood lymphocyte subsets as prognostic indicators for severe acute respiratory syndrome. J Intern Med. 2004; 255(4):512-8. PMC: 7167120. DOI: 10.1111/j.1365-2796.2004.01323.x. View

Chan J, Ng C, Chan Y, Mok T, Lee S, Chu S . Short term outcome and risk factors for adverse clinical outcomes in adults with severe acute respiratory syndrome (SARS). Thorax. 2003; 58(8):686-9. PMC: 1746764. DOI: 10.1136/thorax.58.8.686. View

10.

Karlberg J, Chong D, Lai W . Do men have a higher case fatality rate of severe acute respiratory syndrome than women do?. Am J Epidemiol. 2004; 159(3):229-31. PMC: 7110237. DOI: 10.1093/aje/kwh056. View

11.

Wong R, Wu A, To K, Lee N, Lam C, Wong C . Haematological manifestations in patients with severe acute respiratory syndrome: retrospective analysis. BMJ. 2003; 326(7403):1358-62. PMC: 162124. DOI: 10.1136/bmj.326.7403.1358. View

12.

Vu H, Leitmeyer K, Le D, Miller M, Nguyen Q, Uyeki T . Clinical description of a completed outbreak of SARS in Vietnam, February-May 2003. Emerg Infect Dis. 2004; 10(2):334-8. PMC: 3322907. DOI: 10.3201/eid1002.030761. View

13.

Leung G, Hedley A, Ho L, Chau P, Wong I, Thach T . The epidemiology of severe acute respiratory syndrome in the 2003 Hong Kong epidemic: an analysis of all 1755 patients. Ann Intern Med. 2004; 141(9):662-73. DOI: 10.7326/0003-4819-141-9-200411020-00006. View

14.

Booth C, Matukas L, Tomlinson G, Rachlis A, Rose D, Dwosh H . Clinical features and short-term outcomes of 144 patients with SARS in the greater Toronto area. JAMA. 2003; 289(21):2801-9. DOI: 10.1001/jama.289.21.JOC30885. View

15.

Resnic F, Popma J, Ohno-Machado L . Development and evaluation of models to predict death and myocardial infarction following coronary angioplasty and stenting. Proc AMIA Symp. 2000; :690-3. PMC: 2243827. View

16.

Artigas A, Bernard G, Carlet J, Dreyfuss D, Gattinoni L, Hudson L . The American-European Consensus Conference on ARDS, part 2: Ventilatory, pharmacologic, supportive therapy, study design strategies, and issues related to recovery and remodeling. Acute respiratory distress syndrome. Am J Respir Crit Care Med. 1998; 157(4 Pt 1):1332-47. DOI: 10.1164/ajrccm.157.4.ats2-98. View

17.

Resnic F, Ohno-Machado L, Selwyn A, Simon D, Popma J . Simplified risk score models accurately predict the risk of major in-hospital complications following percutaneous coronary intervention. Am J Cardiol. 2001; 88(1):5-9. DOI: 10.1016/s0002-9149(01)01576-4. View

18.

Lee N, Hui D, Wu A, Chan P, Cameron P, Joynt G . A major outbreak of severe acute respiratory syndrome in Hong Kong. N Engl J Med. 2003; 348(20):1986-94. DOI: 10.1056/NEJMoa030685. View

19.

Tsui P, Kwok M, Yuen H, Lai S . Severe acute respiratory syndrome: clinical outcome and prognostic correlates. Emerg Infect Dis. 2003; 9(9):1064-9. PMC: 3016795. DOI: 10.3201/eid0909.030362. View

20.

Peiris J, Chu C, Cheng V, Chan K, Hung I, Poon L . Clinical progression and viral load in a community outbreak of coronavirus-associated SARS pneumonia: a prospective study. Lancet. 2003; 361(9371):1767-72. PMC: 7112410. DOI: 10.1016/s0140-6736(03)13412-5. View