Outcome of coronavirus-associated severe acute respiratory syndrome using a standard treatment protocol
Outcome of coronavirus-associated severe acute respiratory syndrome using a standard treatment protocol
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DOI：
10.1111/j.1440-1843.2004.00588.x
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发表时间：
2004-06-01
期刊：
影响因子：
6.9
通讯作者：
Yam, LYC
中科院分区：
文献类型：
--
作者：
Lau, ACW;So, LKY;Yam, LYC
目的：目前对冠状病毒相关的严重急性呼吸系统综合征（SARS）的最佳治疗策略尚未达成共识。我们的目的是分析标准治疗策略的结果，包括抗生素、利巴韦林联合用药、3周皮质类固醇降压疗程，以及在病情恶化时使用脉冲甲基强的松龙的可能性。方法：这是一项在香港一家大型公立医院进行的前瞻性队列研究。88例世界卫生组织/疾病控制和预防中心的疑似SARS病例（97%经实验室确诊）采用先前报告的标准方案进行治疗。我们详细分析了71例首次治疗的患者在联合治疗后达到临床稳定所需的时间、额外治疗的需求（脉冲甲基强的松龙、辅助通气）；以及最终结果（康复，死亡率）。结果：平均年龄42岁。21例患者（24%）有合并症。71例新生患者中有3例仅用抗生素治疗后恢复。其余68例在症状出现后平均5.8天接受联合治疗，其中30例随后需要脉冲甲基强的松龙救援（独立预测因素：年龄较大，LDH较高），18例需要辅助通气（独立预测因素：年龄较大，需氧量和肌酐水平较高）。他们在联合治疗后达到临床稳定的中位时间为8.0天（达到稳定时间较长的独立预测因素：中位年龄41岁或以上）。常见的并发症是高血糖（58%）、纵隔/胸腔积气（13%）、精神症状（7%）和呼吸机相关性肺炎（2%）。1例（1%）患者死于sars相关的呼吸衰竭。全因死亡率为3.4%，仅发生在50 ~ 65岁的患者中。出院幸存者均无需继续吸氧治疗。结论：该标准治疗方案总体效果满意。建议进行随机对照试验以证实其疗效。
Objective: There is so far no consensus on the optimal treatment strategy for the coronavirus-associated severe acute respiratory syndrome (SARS). We aimed to analyse the outcomes of a standard treatment strategy comprising antibiotics, a combination of ribavirin, a 3-week step-down course of corticosteroids, and the possibility of pulsed methylprednisolone rescue in the event of deterioration.Methodology: This was a prospective cohort study performed at a major public-funded hospital in Hong Kong. Eighty-eight World Health Organisation/Centers for Disease Control and Prevention probable cases of SARS (97% laboratory-confirmed) were treated with a standard protocol previously reported. Seventy-one patients treated de novo were analysed in detail with regard to time to clinical stabilization after combination treatment, requirement of additional therapy (pulsed methylprednisolone; assisted ventilation); and final outcomes (recovery, mortality).Results: The mean age was 42. Twenty-one patients (24%) had comorbidities. Three of 71 treated de novo recovered with antibiotics alone. The remaining 68 received combination treatment at a mean of 5.8 days after symptom onset, of whom 30 subsequently required pulsed methylprednisolone rescue (independent predictors: older age and higher LDH) and 18 required assisted ventilation (independent predictors: older age, higher oxygen requirement and creatinine level). Their median time to clinical stabilization was 8.0 days after combination treatment (independent predictor for longer time to stabilization: median age of 41 or above). Common complications were hyperglycaemia (58%), pneumo-mediastinum/thoraces (13%), psychiatric manifestations (7%) and ventilator-associated pneumonia (2%). One patient (1%) died of SARS-related respiratory failure. All-cause mortality was 3.4%, occurring in patients aged > 65 years only. None of the discharged survivors required continuation of oxygen therapy.Conclusions: This standard treatment protocol resulted in overall satisfactory outcomes. Randomized controlled trial is suggested to confirm its efficacy.