Clinical predictors of mortality of Middle East Respiratory Syndrome Coronavirus (MERS-CoV) infection: A cohort study

Abstract

Background: Since the emergence of the Middle East Respiratory Syndrome Coronavirus (MERS-CoV) in 2012, the virus had caused a high case fatality rate. The clinical presentation of MERS varied from asymptomatic to severe bilateral pneumonia, depending on the case definition and surveillance strategies. There are few studies examining the mortality predictors in this disease. In this study, we examined clinical predictors of mortality of Middle East Respiratory Syndrome (MERS) infection. Methods: This is a retrospective analysis of symptomatic admitted patients to a large tertiary MERS-CoV center in Saudi Arabia over the period from April 2014 to March 2018. Clinical and laboratory data were collected and analysis was done using a binary regression model. Results: A total of 314 symptomatic MERS-CoV patients were included in the analysis, with a mean age of 48 ( ± 17.3) years. Of these cases, 78 (24.8%) died. The following parameters were associated with increased mortality, age, WBC, neutrophil count, serum albumin level, use of a continuous renal replacement therapy (CRRT) and corticosteroid use. The odd ratio for mortality was highest for CRRT and corticosteroid use (4.95 and 3.85, respectively). The use of interferon-ribavirin was not associated with mortality in this cohort. Conclusion: Several factors contributed to increased mortality in this cohort of MERS-CoV patients. Of these factors, the use of corticosteroid and CRRT were the most significant. Further studies are needed to evaluate whether these factors were a mark of severe disease or actual contributors to higher mortality.

MERS-CoV as an emerging respiratory illness: A review of prevention methods

“…The average incubation period for MERS-CoV is 5-7 days, but a range of 2 days-14 days have been reported [13,14,[19][20][21][22].The clinical disease spectrum ranges from completely asymptomatic, mild disease and severe disease with multi-organ failure [13,14,[19][20][21][22][23][24][25][26]. In a symptomatic patient, symptoms at presentation may include fever, chills, rigors, myalgia, malaise, cough and shortness of breath.…”

“…Gastrointestinal symptoms of diarrhea, vomiting and abdominal pain may be present as part of the upper respiratory syndrome or as the main presenting complain [13]. Pneumonia is common at presentation [13,14,[19][20][21][22][23][24][25][26]. Severe infection occurs specially among older patients with comorbidities and present with acute respiratory, renal failure and shock [24,25].…”

“…Pneumonia is common at presentation [13,14,[19][20][21][22][23][24][25][26]. Severe infection occurs specially among older patients with comorbidities and present with acute respiratory, renal failure and shock [24,25]. The crude fatality rate average is 35% among primary cases and 20% among secondary cases [3,[25][26][27].…”

“…Severe infection occurs specially among older patients with comorbidities and present with acute respiratory, renal failure and shock [24,25]. The crude fatality rate average is 35% among primary cases and 20% among secondary cases [3,[25][26][27]. Predictors of poor outcome includes age above 60 years, male gender, diabetes mellitus, chronic lung disease and chronic renal disease, low albumin level and progressive lymphocytopenia [24][25][26].…”

“…The crude fatality rate average is 35% among primary cases and 20% among secondary cases [3,[25][26][27]. Predictors of poor outcome includes age above 60 years, male gender, diabetes mellitus, chronic lung disease and chronic renal disease, low albumin level and progressive lymphocytopenia [24][25][26]. Use of steroids and continuous renal replacement therapy have also been suggested as predictors of worse outcome [26].…”