High fatality rates and associated factors in two hospital outbreaks of MERS in Daejeon, the Republic of Korea
High fatality rates and associated factors in two hospital outbreaks of MERS in Daejeon, the Republic of Korea
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DOI：
10.1016/j.ijid.2017.02.008
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发表时间：
2017-05-01
影响因子：
8.4
通讯作者：
Kim, Seung Woo
中科院分区：
文献类型：
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作者：
Nam, Hae-Sung;Park, Jung Wan;Kim, Seung Woo
目的：探讨中东呼吸综合征-冠状病毒感染病死率的流行病学和临床预测因素（MERS-CoV）感染在大韩民国大田爆发。我们审查了A医院1例指示病例和25例其他MERS病例的疫情调查报告和医疗记录。结果：B医院的病死率高于A医院（分别为63.6%和28.6%）;在医院B中也发现了较高的MERS CoV暴露条件，包括索引病例中的肺炎加重和在六张病床的入院室中使用雾化器。与高病死率相关的宿主因素是预先存在的肺炎，吸烟史，潜伏期小于5天，白细胞增多，诊断时肾功能异常，呼吸道症状，如痰和呼吸困难。结论：周围MERS冠状病毒暴露的条件和潜在的肺功能差，由于吸烟史或预先存在的肺炎可能解释了医院B的高病死率。上述临床特征可以预测MERS病例的预后。(C)2017作者（S）由Elsevier Ltd代表国际传染病学会出版。
Objectives: To explore the epidemiological and clinical factors predictive of the case fatality rate (CFR) of Middle East respiratory syndrome-coronavirus (MERS-CoV) infection in an outbreak in Daejeon, the Republic of Korea.Methods: We reviewed the outbreak investigation reports and medical records of 1 index case and 25 additional MERS cases in hospitals A (14 cases) and B (11 cases), and conducted an in-depth interview with the index case.Results: The CFR in hospital B was higher than that in hospital A (63.6% vs. 28.6%, respectively). Higher MERS-CoV exposure conditions were also found in hospital B, including aggravated pneumonia in the index case and nebulizer use in a six-bed admission room. The host factors associated with high CFR were pre-existing pneumonia, smoking history, an incubation period of less than 5 days, leukocytosis, abnormal renal function at diagnosis, and respiratory symptoms such as sputum and dyspnea.Conclusions: The conditions surrounding MERS-CoV exposure and the underlying poor pulmonary function due to a smoking history or pre-existing pneumonia may explain the high CFR in hospital B. The clinical features described above may enable prediction of the prognosis of MERS cases. (C) 2017 The Author(s). Published by Elsevier Ltd on behalf of International Society for Infectious Diseases.