Clinical features and short-term outcomes of 144 patients with SARS in the greater Toronto area
Clinical features and short-term outcomes of 144 patients with SARS in the greater Toronto area
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DOI：
10.1001/jama.289.21.joc30885
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发表时间：
2003-06-04
影响因子：
120.7
通讯作者：
Detsky, AS
中科院分区：
文献类型：
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作者：
Booth, CM;Matukas, LM;Detsky, AS
严重急性呼吸综合征（SevereAcuteRespiratorysyndrome，SARS）是2002年11月在中国首次出现的一种新型传染病，随后在全球范围内传播。描述这些患者是如何治疗的，以及与不良结局相关的变量。设计，设置，回顾性病例系列，包括2003年3月7日至4月10日期间在安大略大多伦多地区的10所学术和社区医院住院的144名成人患者，诊断为疑似或可能的SARS。如果患者有发热、已知暴露于SARS、呼吸道症状或胸片上观察到浸润，则将其纳入研究。排除患者，如果一个替代diagnosis determined.Main结果测量暴露于SARS的位置，在入院时的历史，体格检查和实验室检查的功能，和21天的结果，如死亡或重症监护病房（ICU）入院或不机械ventilation.Results的144例患者中，111（77%）暴露于SARS在医院设置。这些患者入院时最常见的临床检查特征是自我报告的发热（99%）、记录的体温升高（85%）、干咳（69%）、肌痛（49%）和呼吸困难（42%）。常见的实验室特征包括乳酸脱氢酶升高（87%）、低钙血症（60%）和淋巴细胞减少症（54%）。只有2%的患者有阴道溢液。共有126名患者（88%）接受利巴韦林治疗，尽管其使用与显著毒性相关，包括溶血（76%）和血红蛋白降低2 g/dL（49%）。29例患者（20%）入住ICU，接受或不接受机械通气，8例患者死亡（21天死亡率，6.5%; 95%置信区间[CI]，1.9%-11.8%）。多变量分析显示，糖尿病的存在（相对风险[RR]，3.1; 95% CI，1.4-7.2; P=.01）或其他共病（RR，2.5; 95% CI，1.1-5.8; P=.03）与不良结局独立相关结论大多伦多地区SARS暴发的大多数病例与医院暴露有关。在接触史变得不可靠的情况下，临床表现的几个特征将有助于提高对SARS的怀疑。尽管SARS与显著的发病率和死亡率相关，特别是在糖尿病或其他合并症患者中，但我们队列中绝大多数（93.5%）患者存活。
Context Severe acute respiratory syndrome (SARS) is an emerging infectious disease that first manifested in humans in China in November 2002 and has subsequently spread worldwide.Objectives To describe the clinical characteristics and short-term outcomes of SARS in the first large group of patients in North America; to describe how these patients were treated and the variables associated with poor outcome.Design, Setting, and Patients Retrospective case series involving 144 adult patients admitted to 10 academic and community hospitals in the greater Toronto, Ontario, area between March 7 and April 10, 2003, with a diagnosis of suspected or probable SARS. Patients were included if they had fever, a known exposure to SARS, and respiratory symptoms or infiltrates observed on chest radiograph. Patients were excluded if an alternative diagnosis was determined.Main Outcome Measures Location of exposure to SARS; features of the history, physical examination, and laboratory tests at admission to the hospital; and 21-day outcomes such as death or intensive care unit (ICU) admission with or without mechanical ventilation.Results Of the 144 patients, 111 (77%) were exposed to SARS in the hospital setting. Features of the clinical examination most commonly found in these patients at admission were self-reported fever (99%), documented elevated temperature (85%), nonproductive cough (69%), myalgia (49%), and dyspnea (42%). Common laboratory features included elevated lactate dehydrogenase (87%), hypocalcemia (60%), and lymphopenia,(54%). Only 2% of patients had rhinorrhea. A total of 126 patients (88%) were treated with ribavirin, although its use was associated with significant toxicity, including hemolysis (in 76%) and decrease in hemoglobin of 2 g/dL (in 49%). Twenty-nine patients (20%) were admitted to the ICU with or without mechanical ventilation, and 8 patients died (21-day mortality, 6.5%; 95% confidence interval [CI], 1.9%-11.8%). Multivariable analysis showed that the presence of diabetes (relative risk [RR], 3.1; 95% CI, 1.4-7.2; P=.01) or other comorbid conditions (RR, 2.5; 95% CI, 1.1-5.8; P=.03) were independently associated with poor outcome (death, ICU admission, or mechanical ventilation).Conclusions The majority of cases in the SARS outbreak in the greater Toronto area were related to hospital exposure. In the event that contact history becomes unreliable, several features of the clinical presentation will be useful in raising the suspicion of SARS. Although SARS is associated with significant morbidity and mortality, especially in patients with diabetes or other comorbid conditions, the vast majority (93.5%) of patients in our cohort survived.