Initial viral load and the outcomes of SARS
Initial viral load and the outcomes of SARS
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DOI：
10.1503/cmaj.1040398
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发表时间：
2004-11-23
影响因子：
14.6
通讯作者：
Yuen, KY
中科院分区：
文献类型：
--
作者：
Chu, CM;Poon, LLM;Yuen, KY
背景：严重急性呼吸综合征（SARS）是由一种新型冠状病毒引起的。它可能进展为呼吸衰竭，并且相当大比例的患者死亡。初步数据表明，SARS冠状病毒的高病毒载量与重症监护室的不良后果有关，但病毒载量与生存的关系尚不清楚。方法：我们前瞻性研究了一个初始队列，其中包括133名病毒学确诊的SARS患者，这些患者于2003年3月24日至5月4日入住香港2家普通急症护理医院。对患者进行随访直至死亡或至少90天。我们使用考克斯比例风险模型来分析潜在的预测生存记录的时间介绍，包括鼻咽标本的病毒载量（测量SARS相关冠状病毒的定量逆转录酶聚合酶链反应[PCR]）。结果：32例（24.1%）符合急性呼吸窘迫综合征的标准，24例（18.0%）死亡。以下基线因素与生存率下降独立相关：年龄较大（61-80岁）（校正的风险比[HR] 5.24，95%置信区间[CI] 2.03-13.53），存在活动性共病（校正HR 3.36，95%CI 1.44-7.82）和较高的SARS冠状病毒初始病毒载量（校正HR 1.21/log，每毫升RNA拷贝数增加，95%CI 1.06-1.39）。解释：我们发现初步证据表明，较高的初始病毒载量与SARS预后不良独立相关。SARS患者的死亡率数据应根据年龄、合并症和病毒载量来解释。这些考虑在今后的SARS研究中将是重要的。
Background: Severe acute respiratory syndrome (SARS) is caused by a novel coronavirus. It may progress to respiratory failure, and a significant proportion of patients die. Preliminary data suggest that a high viral load of the SARS coronavirus is associated with adverse outcomes in the intensive care unit, but the relation of viral load to survival is unclear.Methods: We prospectively studied an inception cohort of 133 patients with virologically confirmed SARS who were admitted to 2 general acute care hospitals in Hong Kong from Mar. 24 to May 4, 2003. The patients were followed until death or for a minimum of 90 days. We used Cox proportional hazard modelling to analyze potential predictors of survival recorded at the time of presentation, including viral load from nasopharyngeal specimens (measured by quantitative reverse transcriptase polymerase chain reaction [PCR] of the SARS-associated coronavirus).Results: Thirty-two patients (24.1 %) met the criteria for acute respiratory distress syndrome, and 24 patients (18.0%) died. The following baseline factors were independently associated with worse survival: older age (61-80 years) (adjusted hazard ratio [HR] 5.24, 95% confidence interval [CI] 2.03-13.53), presence of an active comorbid condition (adjusted HR 3.36, 95% CI 1.44-7.82) and higher initial viral load of SARS coronavirus, according to quantitative PCR of nasopharyngeal specimens (adjusted HR 1.21 per log,, increase in number of RNA copies per millilitre, 95% CI 1.06-1.39).Interpretation: We found preliminary evidence that higher initial viral load is independently associated with worse prognosis in SARS. Mortality data for patients with SARS should be interpreted in light of age, comorbiclity and viral load. These considerations will be important in future studies of SARS.