Outcomes and Prognostic Factors in 267 Patients with Severe Acute Respiratory Syndrome in Hong Kong

Choi, Kin Wing; Chau, Tai Nin; Tsang, Owen Tak‐Yin; Tso, Eugene Yuk‐Keung; Chiu, Ming Chee; Tong, Wing Lok; Lee, Po Oi; Ng, Tak Keung; Ng, Wai Fu; Lee, Kam Cheong; Lam, William; Yu, Wai Cho; Lai, Jak Yiu; Lai, Sik To

doi:10.7326/0003-4819-139-9-200311040-00005

Cited by 370 publications

(383 citation statements)

References 17 publications

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“…Conversely, the fact that increased LDH level at admission was a risk factor for hospital mortality in our series probably reflected the prognostic impact of pulmonary injury. Previous studies have demonstrated that increased LDH level in patients with pulmonary pneumocystosis or acute respiratory distress syndrome is a prognostic factor [32,33]. However, increase in LDH level can be the result of various conditions which makes its interpretation speculative [34].…”

Section: Discussionmentioning

confidence: 99%

Diffuse alveolar haemorrhage: factors associated with in-hospital and long-term mortality

Prost¹,

Parrot²,

Picard³

et al. 2009

Eur Respir J

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Diffuse alveolar haemorrhage (DAH) is a feature of several immune and nonimmune disorders. Reported prognosis is poor, with in-hospital mortality ranging from 20% to 100%. Early identification of prognostic factors may be useful in the initiation of appropriate treatment.We retrospectively analysed the charts of all patients referred to a university hospital for DAH between 1980 and 2008. Variables associated with in-hospital and long-term mortality were determined using a logistic regression model and the Kaplan-Meier method, respectively. Immunosuppressed patients were excluded.Overall, 97 patients were included in the study. In-hospital mortality was 24.7%. Factors associated with in-hospital mortality were shock (OR 77.5, 95% CI 8.9-677.2), glomerular filtration rate ,60 mL?min -1 (OR 11.2, 95% CI 1.8-68.4) and plasmatic lactate dehydrogenase level more than twice the normal value (OR 12.1, 95% CI 1.7-84.3). Mortality among discharged patients was 16.4% with a median follow-up duration of 34 months. Factors associated with increased longterm mortality in univariate analysis were age over 60 yrs (p50.026), cardiovascular comorbidity (p50.027) and end-stage renal failure with dependence on haemodialysis (p50.026).Patients with immune and nonimmune DAH had similar outcomes. Early outcome depended on nonpulmonary organ failures. Conversely, late outcome was related to age, cardiac comorbidities and the need for haemodialysis.

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Section: Discussionmentioning

confidence: 99%

Diffuse alveolar haemorrhage: factors associated with in-hospital and long-term mortality

Prost¹,

Parrot²,

Picard³

et al. 2009

Eur Respir J

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“…In adult series, the independent predictors of severe illness are advanced age, high initial absolute neutrophil counts, high initial or peak lactate dehydrogenase levels, and positive RT-PCR results for NPA samples. 7,13,28,29 Our clinical case definition has very good sensitivity (97.8%) and specificity (92.7%) in field testing and served us well during the SARS outbreak. However, early in an outbreak, an epidemiologic clue might not be available to satisfy the requirement in the case definition, even for an actual case.…”

Section: Discussionmentioning

confidence: 99%

Severe Acute Respiratory Syndrome Among Children

Leung¹,

Kwan²,

et al. 2004

Pediatrics

121

152

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ABSTRACT. Objective. To study the epidemiologic, clinical, laboratory, and radiologic features, prognostic indicators, and short-term to medium-term outcomes for children with severe acute respiratory syndrome (SARS) and to validate the performance characteristics of a clinical case definition, calculated with respect to SARSassociated coronavirus (SARS-CoV) seroconversion.Methods. Children <18 years of age, from a singlesite outbreak, who satisfied a clinical case definition for SARS, with subsequent serologic confirmation, were treated according to a standard protocol and prospectively monitored.Results. Forty-four children were included. The median age was 12 years. Forty-two children (95.5%) demonstrated an epidemiologic link. Fever, cough, malaise, coryza, sputum production, headache, myalgia, lymphopenia, and elevated lactate dehydrogenase levels were common presenting features. Radiographic findings were nonspecific, but high-resolution computed tomography of the thorax was an early diagnostic aid. A specific reverse transcription-polymerase chain reaction assay for SARS-CoV yielded positive results for <50% of children. Of 9 children who developed hypoxemia, 8 were treated with methylprednisolone. Of 5 children who received intensive care, 3 required assisted ventilation. All children recovered, and serious adverse events in response to treatment were not observed. The outcomes at 3 to 6 months after disease onset, including exercise tolerance, pulmonary functions, and psychologic status, were favorable. An age of >12 years was associated with methylprednisolone therapy for severe illness. After exclusion of the only infant, an age of >12 years was associated with oxygen requirements. Sore throat, high neutrophil count at presentation, and peak neutrophilia were independent factors predicting severe illness. The clinical case definition demonstrated good sensitivity, specificity, and positive and negative predictive values (97.8%, 92.7%, 88%, and 98.7%, respectively) for diagnostic accuracy.Conclusions. 1 Although the majority were adults, 121 children (6.9%) Ͻ18 years of age were registered, yielding an age-specific attack rate of 8.9 cases per 100 000 persons Ͻ18 years of age and a case fatality rate of 0%. A total of 89 hospitalized children in Hong Kong demonstrated serologic evidence of infection by the SARS-associated coronavirus (SARS-CoV) (e-SARS database, Hospital Authority, Hong Kong Special Administrative Region, data on file).Published articles on pediatric SARS have focused on reporting the demographic, clinical, laboratory, and radiologic characteristics. Definitive virologic data, prognostic indicators, and short-term to medium-term follow-up information were lacking in those preliminary reports. [2][3][4] We prospectively monitored a cohort of 44 children with laboratory confirmation of SARS who were treated at a referral center for pediatric infectious diseases that admitted the largest number of pediatric patients with SARS in Hong Kong. Their epidemiologic links; clinical, laboratory,...

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“…The reported epidemiology, etiology and prognosis varied in different studies. This may be attributed to the absence of a uniform definition for this syndrome [4,5,6,7], the difference in sex and age [8,9,10,11,12] of the population studied or the heterogeneity of conditions [13,14,15,16,17,18,19]. The impact of race and geography also has to be taken into consideration.…”

Section: Introductionmentioning

confidence: 99%

Retrospective Analysis on Chinese Patients Diagnosed with Acute Renal Failure Hospitalized during the Last Decade (1994–2003)

Wang

Cui

Fan³

2005

Am J Nephrol

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Objectives: To investigate the epidemiology, diagnosis and prognosis of acute renal failure (ARF) in hospitalized Chinese during the last decade. Methods: The diagnosis of patients with ARF in Peking University Third Hospital from January 1994 to December 2003 was reconfirmed and the data of epidemiology, etiology and prognosis were analyzed. Results: Only 209 discharged cases were diagnosed with ARF and all were reconfirmed. Two peak occurrences were found at ages of 35–45 and 60–80 with a male predominance of approximately 59.7%. Patients diagnosed with ARF accounted for 1.19‰ of the admissions in the same period and increased significantly in the last 5 years (p = 0.038). The creatinine level at diagnosis was 345.8 ± 122.6 µmol/l and had no significant change (p > 0.05). The percent of hospital-acquired ARF (HA-ARF) demonstrated a significant increase in 1999–2003 compared to 1994–1998 (p = 0.008). Intrarenal ARF accounted for 73.69% and was multifactorial, with drugs, infections and operations as leading causes. Renal biopsy was performed in 37.32% (78/209) with 53.84% (42/78) having acute interstitial nephritis. Maintenance dialysis was discontinued in 46.41% because their renal function completely or partially recovered. The overall mortality was 37.91% without improvement over time. The mortality was 6.25% for patients in nephrology department, but 65.51% in ICU (p < 0.001), and was 21.6% for patients in community-acquired ARF (CA-ARF), but 63.1% in HA-ARF (p < 0.001). Conclusions: During the past 10 years, the number of patients diagnosed with ARF has been rising in hospitalized Chinese. HA-ARF was the major source, and infections, drugs and operations were the leading causes. The diagnosis and prognosis of acute renal failure did not improve much in this population over the decade studied.

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Outcomes and Prognostic Factors in 267 Patients with Severe Acute Respiratory Syndrome in Hong Kong

Cited by 370 publications

References 17 publications

Diffuse alveolar haemorrhage: factors associated with in-hospital and long-term mortality

Diffuse alveolar haemorrhage: factors associated with in-hospital and long-term mortality

Severe Acute Respiratory Syndrome Among Children

Retrospective Analysis on Chinese Patients Diagnosed with Acute Renal Failure Hospitalized during the Last Decade (1994–2003)

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