Outcomes and prognostic factors in 267 patients with severe acute respiratory syndrome in Hong Kong
Outcomes and prognostic factors in 267 patients with severe acute respiratory syndrome in Hong Kong
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DOI：
10.7326/0003-4819-139-9-200311040-00005
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发表时间：
2003-11-04
影响因子：
39.2
通讯作者：
Lai, ST
中科院分区：
文献类型：
--
作者：
Choi, KW;Chau, TN;Lai, ST
背景：严重急性呼吸系统综合征（SARS）已成为全球突发公共卫生事件。目的：评估香港SARS患者的特点和预后，并确定死亡率的预测因素。设计：回顾性队列研究。地点：香港隔离SARS病人的医院。患者：2003年2月26日至3月31日期间，有267名疑似或确诊的SARS患者连续住院。测量：临床、实验室和放射学测量；3个月死亡率。结果：根据病例定义，确诊病例227例，疑似病例40例。常见的症状为发热（99%）、发冷（74%）、不适（63%）和肌痛（50%）。实验室结果包括淋巴细胞减少（73%）、血小板减少（50%）、低钠血症（60%）、乳酸脱氢酶（47%）和c反应蛋白（75%）水平升高。在住院期间，腹泻（53%）、贫血（53%）和急性肾衰竭（6%）的发生率增加。69例（26%）患者因呼吸衰竭需要重症监护。3个月死亡率为12% （95% Cl, 8% ~ 16%）。导致死亡的因素有呼吸衰竭、急性肾功能衰竭和院内败血症。多因素Cox回归显示，年龄大于60岁（相对危险度为5.10 [Cl, 2.30 ~ 11.31], P < 0.001）和发病时乳酸脱氢酶水平大于3.8 mu kat/L（相对危险度为2.20 [Cl, 1.03 ~ 4.71], P = 0.04）是死亡的独立预测因素。结论：由于我们的队列随访时间较长，这些患者的死亡率高于以往研究报告的死亡率。高龄和发病时乳酸脱氢酶水平高可预测死亡率。
Background: severe acute respiratory syndrome (SARS) has become a global public health emergency.Objective: To evaluate the characteristics and outcomes of patients with SARS in Hong Kong and to identify predictors of mortality.Design: Retrospective cohort study.Setting: Quarantine hospital for patients with SARS in Hong Kong.Patients: 267 consecutive patients hospitalized from 26 February to 31 March 2003 for probable or confirmed SARS.Measurements: Clinical, laboratory, and radiographic measures; 3-month mortality rate.Results: According to our case definition, there were 227 cases of confirmed SARS and 40 cases of probable SARS. Common presenting symptoms were fever (99% of patients), chills (74%), malaise (63%), and myalgia (50%). Laboratory findings included lymphopenia (73%), thrombocytopenia (50%), hyponatremia (60%), and elevated levels of lactate dehydrogenase (47%) and C-reactive protein (75%). During hospitalization, incidence of diarrhea (53%), anemia (53%), and acute renal failure (6%) increased. Sixty-nine patients (26%) required intensive care because of respiratory failure. The 3-month mortality rate was 12% (95% Cl, 8% to 16%). Factors contributing to mortality were respiratory failure, acute renal failure, and nosocomial sepsis. On multivariate Cox regression, age older than 60 years (relative risk, 5.10 [Cl, 2.30 to 11.31]; P < 0.001) and lactate dehydrogenase level greater than 3.8 mu kat/L at presentation (relative risk, 2.20 [Cl, 1.03 to 4.71]; P = 0.04) were independent predictors of mortality.Conclusion: Because of the longer follow-up period in our cohort, the mortality rate in these patients is higher than rates reported in previous studies. Advanced age and high lactate dehydrogenase level at presentation predict mortality.