Critically Ill Patients With the Middle East Respiratory Syndrome: A Multicenter Retrospective Cohort Study
Critically Ill Patients With the Middle East Respiratory Syndrome: A Multicenter Retrospective Cohort Study
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DOI：
10.1097/ccm.0000000000002621
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发表时间：
2017-10-01
影响因子：
8.8
通讯作者：
Balkhy, Hanan H.
中科院分区：
文献类型：
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作者：
Arabi, Yaseen M.;Al-Omari, Awad;Balkhy, Hanan H.
目的：描述中东呼吸综合征重症急性呼吸道感染患者的特征、临床表现、病程（包括病毒复制模式）和结局，并将这些特征与其他病因所致的重症急性呼吸道感染患者进行比较。设计：回顾性队列研究。设置：14家沙特阿拉伯医院ICU收治的患者。患者：将2012年9月至2015年10月期间收治的实验室确诊的中东呼吸综合征严重急性呼吸道感染危重患者（n = 330）与非中东呼吸综合征病因的社区获得性严重急性呼吸道感染连续危重患者进行比较（非中东呼吸综合征严重急性呼吸道感染）（n = 222）。干预措施：无。测量和主要结果：虽然中东呼吸综合征严重急性呼吸道感染患者比非感染者年轻，中东呼吸综合征严重急性呼吸道感染（中位数[四分位数1，四分位数3] 58岁[44，69] vs 70岁[52，78]; p < 0.001），临床表现和合并症基本重叠。中东呼吸综合征严重急性呼吸道感染患者的低氧血症性呼吸衰竭更严重（Pao（2）/Fio（2）：106 [66，160] vs 176 [104，252]; p < 0.001），非呼吸器官衰竭更频繁（非呼吸性序贯器官衰竭评估评分：6 [4，9] vs 5 [3，7]; p = 0.002），因此需要更频繁的有创机械通气（85.2% vs 73.0%; p < 0.001），氧气急救治疗（体外膜氧合5.8% vs 0.9%; p = 0.003），血管加压药支持（79.4% vs 55.0%; p < 0.001）和肾脏替代治疗（48.8% vs 22.1%; p < 0.001）。在调整潜在的混杂因素后，与非中东呼吸综合征严重急性呼吸道感染相比，中东呼吸综合征与死亡独立相关（调整的比值比，5.87; 95%CI，4.02-8.56; p < 0.001）。中东呼吸综合征严重急性呼吸道感染患者的临床表现和合并症与其他因此，高度怀疑与诊断检测相结合是对高危患者进行严重急性呼吸道感染调查的重要组成部分。缺乏明显的临床特征，需要依赖于呼吸道样本的实时逆转录聚合酶链反应，病毒脱落持续时间的可变性，缺乏有效的治疗，以及高死亡率代表了重大的临床挑战，并有助于指导正在进行的临床研究工作。
Objectives: To describe patient characteristics, clinical manifestations, disease course including viral replication patterns, and outcomes of critically ill patients with severe acute respiratory infection from the Middle East respiratory syndrome and to compare these features with patients with severe acute respiratory infection due to other etiologies.Design: Retrospective cohort study.Setting: Patients admitted to ICUs in 14 Saudi Arabian hospitals.Patients: Critically ill patients with laboratory-confirmed Middle East respiratory syndrome severe acute respiratory infection (n = 330) admitted between September 2012 and October 2015 were compared to consecutive critically ill patients with community-acquired severe acute respiratory infection of non-Middle East respiratory syndrome etiology (non-Middle East respiratory syndrome severe acute respiratory infection) (n = 222).Interventions: None.Measurements and Main Results: Although Middle East respiratory syndrome severe acute respiratory infection patients were younger than those with non-Middle East respiratory syndrome severe acute respiratory infection (median [quartile 1, quartile 3] 58 yr [44, 69] vs 70 [52, 78]; p < 0.001), clinical presentations and comorbidities overlapped substantially. Patients with Middle East respiratory syndrome severe acute respiratory infection had more severe hypoxemic respiratory failure (Pao(2)/Fio(2) : 106 [66, 160] vs 176 [104, 252]; p < 0.001) and more frequent nonrespiratory organ failure (nonrespiratory Sequential Organ Failure Assessment score: 6 [4, 9] vs 5 [3, 7]; p = 0.002), thus required more frequently invasive mechanical ventilation (85.2% vs 73.0%; p < 0.001), oxygen rescue therapies (extracorporeal membrane oxygenation 5.8% vs 0.9%; p = 0.003), vasopressor support (79.4% vs 55.0%; p < 0.001), and renal replacement therapy (48.8% vs 22.1%; p < 0.001). After adjustment for potential confounding factors, Middle East respiratory syndrome was independently associated with death compared to non-Middle East respiratory syndrome severe acute respiratory infection (adjusted odds ratio, 5.87; 95% CI, 4.02-8.56; p < 0.001).Conclusions: Substantial overlap exists in the clinical presentation and comorbidities among patients with Middle East respiratory syndrome severe acute respiratory infection from other etiologies; therefore, a high index of suspicion combined with diagnostic testing is essential component of severe acute respiratory infection investigation for at-risk patients. The lack of distinguishing clinical features, the need to rely on real-time reverse transcription polymerase chain reaction from respiratory samples, variability in viral shedding duration, lack of effective therapy, and high mortality represent substantial clinical challenges and help guide ongoing clinical research efforts.