A Comparative Study of Clinical Presentation and Risk Factors for Adverse Outcome in Patients Hospitalised with Acute Respiratory Disease Due to MERS Coronavirus or Other Causes
Identifieur interne : 000C75 ( Pmc/Checkpoint ); précédent : 000C74; suivant : 000C76A Comparative Study of Clinical Presentation and Risk Factors for Adverse Outcome in Patients Hospitalised with Acute Respiratory Disease Due to MERS Coronavirus or Other Causes
Auteurs : Musa A. Garbati [Arabie saoudite] ; Shamsudeen F. Fagbo [Arabie saoudite] ; Vicky J. Fang ; Leila Skakni [Arabie saoudite] ; Mercy Joseph [Arabie saoudite] ; Tariq A. Wani [Arabie saoudite] ; Benjamin J. Cowling ; Malik Peiris ; Ahmed Hakawi [Arabie saoudite]Source :
- PLoS ONE [ 1932-6203 ] ; 2016.
Abstract
Middle East Respiratory syndrome (MERS) first emerged in Saudi Arabia in 2012 and remains a global health concern. The objective of this study was to compare the clinical features and risk factors for adverse outcome in patients with RT-PCR confirmed MERS and in those with acute respiratory disease who were MERS-CoV negative, presenting to the King Fahad Medical City (KFMC) in Riyadh between October 2012 and May 2014. The demographics, clinical and laboratory characteristics and clinical outcomes of patients with RT-PCR confirmed MERS-CoV infection was compared with those testing negative MERS-CoV PCR. Health care workers (HCW) with MERS were compared with MERS patients who were not health care workers. One hundred and fifty nine patients were eligible for inclusion. Forty eight tested positive for MERS CoV, 44 (92%) being hospital acquired infections and 23 were HCW. There were 111 MERS-CoV negative patients with acute respiratory illnesses included in this study as “negative controls”. Patient with confirmed MERS-CoV infection were not clinically distinguishable from those with negative MERS-CoV RT-PCR results although diarrhoea was commoner in MERS patients. A high level of suspicion in initiating laboratory tests for MERS-CoV is therefore indicated. Variables associated with adverse outcome were older age and diabetes as a co-morbid illness. Interestingly, co-morbid illnesses other than diabetes were not significantly associated with poor outcome. Health care workers with MERS had a markedly better clinical outcome compared to non HCW MERS patients.
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DOI: 10.1371/journal.pone.0165978
PubMed: 27812197
PubMed Central: 5094725
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Garbati</name><affiliation wicri:level="1"><nlm:aff id="aff001"><addr-line>King Fahad Medical City, Riyadh, Saudi Arabia</addr-line></nlm:aff><country xml:lang="fr">Arabie saoudite</country><wicri:regionArea>King Fahad Medical City, Riyadh</wicri:regionArea><wicri:noRegion>Riyadh</wicri:noRegion></affiliation></author><author><name sortKey="Fagbo, Shamsudeen F" sort="Fagbo, Shamsudeen F" uniqKey="Fagbo S" first="Shamsudeen F." last="Fagbo">Shamsudeen F. Fagbo</name><affiliation wicri:level="1"><nlm:aff id="aff001"><addr-line>King Fahad Medical City, Riyadh, Saudi Arabia</addr-line></nlm:aff><country xml:lang="fr">Arabie saoudite</country><wicri:regionArea>King Fahad Medical City, Riyadh</wicri:regionArea><wicri:noRegion>Riyadh</wicri:noRegion></affiliation></author><author><name sortKey="Fang, Vicky J" sort="Fang, Vicky J" uniqKey="Fang V" first="Vicky J." last="Fang">Vicky J. Fang</name><affiliation><nlm:aff id="aff002"><addr-line>School of Public Health, The University of Hong Kong, Hong Kong SAR</addr-line></nlm:aff><wicri:noCountry code="subfield">Hong Kong SAR</wicri:noCountry></affiliation></author><author><name sortKey="Skakni, Leila" sort="Skakni, Leila" uniqKey="Skakni L" first="Leila" last="Skakni">Leila Skakni</name><affiliation wicri:level="1"><nlm:aff id="aff001"><addr-line>King Fahad Medical City, Riyadh, Saudi Arabia</addr-line></nlm:aff><country xml:lang="fr">Arabie saoudite</country><wicri:regionArea>King Fahad Medical City, Riyadh</wicri:regionArea><wicri:noRegion>Riyadh</wicri:noRegion></affiliation></author><author><name sortKey="Joseph, Mercy" sort="Joseph, Mercy" uniqKey="Joseph M" first="Mercy" last="Joseph">Mercy Joseph</name><affiliation wicri:level="1"><nlm:aff id="aff001"><addr-line>King Fahad Medical City, Riyadh, Saudi Arabia</addr-line></nlm:aff><country xml:lang="fr">Arabie saoudite</country><wicri:regionArea>King Fahad Medical City, Riyadh</wicri:regionArea><wicri:noRegion>Riyadh</wicri:noRegion></affiliation></author><author><name sortKey="Wani, Tariq A" sort="Wani, Tariq A" uniqKey="Wani T" first="Tariq A." last="Wani">Tariq A. Wani</name><affiliation wicri:level="1"><nlm:aff id="aff001"><addr-line>King Fahad Medical City, Riyadh, Saudi Arabia</addr-line></nlm:aff><country xml:lang="fr">Arabie saoudite</country><wicri:regionArea>King Fahad Medical City, Riyadh</wicri:regionArea><wicri:noRegion>Riyadh</wicri:noRegion></affiliation></author><author><name sortKey="Cowling, Benjamin J" sort="Cowling, Benjamin J" uniqKey="Cowling B" first="Benjamin J." last="Cowling">Benjamin J. Cowling</name><affiliation><nlm:aff id="aff002"><addr-line>School of Public Health, The University of Hong Kong, Hong Kong SAR</addr-line></nlm:aff><wicri:noCountry code="subfield">Hong Kong SAR</wicri:noCountry></affiliation></author><author><name sortKey="Peiris, Malik" sort="Peiris, Malik" uniqKey="Peiris M" first="Malik" last="Peiris">Malik Peiris</name><affiliation><nlm:aff id="aff002"><addr-line>School of Public Health, The University of Hong Kong, Hong Kong SAR</addr-line></nlm:aff><wicri:noCountry code="subfield">Hong Kong SAR</wicri:noCountry></affiliation></author><author><name sortKey="Hakawi, Ahmed" sort="Hakawi, Ahmed" uniqKey="Hakawi A" first="Ahmed" last="Hakawi">Ahmed Hakawi</name><affiliation wicri:level="1"><nlm:aff id="aff001"><addr-line>King Fahad Medical City, Riyadh, Saudi Arabia</addr-line></nlm:aff><country xml:lang="fr">Arabie saoudite</country><wicri:regionArea>King Fahad Medical City, Riyadh</wicri:regionArea><wicri:noRegion>Riyadh</wicri:noRegion></affiliation></author></analytic><series><title level="j">PLoS ONE</title><idno type="eISSN">1932-6203</idno><imprint><date when="2016">2016</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p>Middle East Respiratory syndrome (MERS) first emerged in Saudi Arabia in 2012 and remains a global health concern. The objective of this study was to compare the clinical features and risk factors for adverse outcome in patients with RT-PCR confirmed MERS and in those with acute respiratory disease who were MERS-CoV negative, presenting to the King Fahad Medical City (KFMC) in Riyadh between October 2012 and May 2014. The demographics, clinical and laboratory characteristics and clinical outcomes of patients with RT-PCR confirmed MERS-CoV infection was compared with those testing negative MERS-CoV PCR. Health care workers (HCW) with MERS were compared with MERS patients who were not health care workers. One hundred and fifty nine patients were eligible for inclusion. Forty eight tested positive for MERS CoV, 44 (92%) being hospital acquired infections and 23 were HCW. There were 111 MERS-CoV negative patients with acute respiratory illnesses included in this study as “negative controls”. Patient with confirmed MERS-CoV infection were not clinically distinguishable from those with negative MERS-CoV RT-PCR results although diarrhoea was commoner in MERS patients. A high level of suspicion in initiating laboratory tests for MERS-CoV is therefore indicated. Variables associated with adverse outcome were older age and diabetes as a co-morbid illness. Interestingly, co-morbid illnesses other than diabetes were not significantly associated with poor outcome. Health care workers with MERS had a markedly better clinical outcome compared to non HCW MERS patients.</p></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Zaki, Am" uniqKey="Zaki A">AM Zaki</name></author><author><name sortKey="Van Boheemen, S" uniqKey="Van Boheemen S">S van Boheemen</name></author><author><name sortKey="Bestebroer, Tm" uniqKey="Bestebroer T">TM Bestebroer</name></author><author><name sortKey="Osterhaus, Ad" uniqKey="Osterhaus A">AD Osterhaus</name></author><author><name sortKey="Fouchier, Ra" uniqKey="Fouchier R">RA Fouchier</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Azhar, Ei" uniqKey="Azhar E">EI Azhar</name></author><author><name sortKey="El Kafrawy, Sa" uniqKey="El Kafrawy S">SA El-Kafrawy</name></author><author><name sortKey="Farraj, Sa" uniqKey="Farraj S">SA Farraj</name></author><author><name sortKey="Hassan, Am" uniqKey="Hassan A">AM 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<front><journal-meta><journal-id journal-id-type="nlm-ta">PLoS One</journal-id><journal-id journal-id-type="iso-abbrev">PLoS ONE</journal-id><journal-id journal-id-type="publisher-id">plos</journal-id><journal-id journal-id-type="pmc">plosone</journal-id><journal-title-group><journal-title>PLoS ONE</journal-title></journal-title-group><issn pub-type="epub">1932-6203</issn><publisher><publisher-name>Public Library of Science</publisher-name><publisher-loc>San Francisco, CA USA</publisher-loc></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">27812197</article-id><article-id pub-id-type="pmc">5094725</article-id><article-id pub-id-type="doi">10.1371/journal.pone.0165978</article-id><article-id pub-id-type="publisher-id">PONE-D-16-32266</article-id><article-categories><subj-group subj-group-type="heading"><subject>Research Article</subject></subj-group><subj-group subj-group-type="Discipline-v3"><subject>Biology and life 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subj-group-type="Discipline-v3"><subject>Medicine and Health Sciences</subject><subj-group><subject>Pulmonology</subject><subj-group><subject>Respiratory Infections</subject></subj-group></subj-group></subj-group><subj-group subj-group-type="Discipline-v3"><subject>Biology and Life Sciences</subject><subj-group><subject>Molecular Biology</subject><subj-group><subject>Molecular Biology Techniques</subject><subj-group><subject>Artificial Gene Amplification and Extension</subject><subj-group><subject>Polymerase Chain Reaction</subject><subj-group><subject>Reverse Transcriptase-Polymerase Chain Reaction</subject></subj-group></subj-group></subj-group></subj-group></subj-group></subj-group><subj-group subj-group-type="Discipline-v3"><subject>Research and Analysis Methods</subject><subj-group><subject>Molecular Biology Techniques</subject><subj-group><subject>Artificial Gene Amplification and Extension</subject><subj-group><subject>Polymerase Chain Reaction</subject><subj-group><subject>Reverse Transcriptase-Polymerase Chain Reaction</subject></subj-group></subj-group></subj-group></subj-group></subj-group><subj-group subj-group-type="Discipline-v3"><subject>People and Places</subject><subj-group><subject>Demography</subject></subj-group></subj-group><subj-group subj-group-type="Discipline-v3"><subject>Medicine and Health Sciences</subject><subj-group><subject>Gastroenterology and Hepatology</subject><subj-group><subject>Diarrhea</subject></subj-group></subj-group></subj-group><subj-group subj-group-type="Discipline-v3"><subject>Medicine and Health Sciences</subject><subj-group><subject>Diagnostic Medicine</subject><subj-group><subject>Signs and Symptoms</subject><subj-group><subject>Diarrhea</subject></subj-group></subj-group></subj-group></subj-group><subj-group subj-group-type="Discipline-v3"><subject>Medicine and Health Sciences</subject><subj-group><subject>Pathology and Laboratory Medicine</subject><subj-group><subject>Signs and Symptoms</subject><subj-group><subject>Diarrhea</subject></subj-group></subj-group></subj-group></subj-group><subj-group subj-group-type="Discipline-v3"><subject>Medicine and Health Sciences</subject><subj-group><subject>Infectious Diseases</subject><subj-group><subject>Nosocomial Infections</subject></subj-group></subj-group></subj-group><subj-group subj-group-type="Discipline-v3"><subject>People and places</subject><subj-group><subject>Geographical locations</subject><subj-group><subject>Asia</subject><subj-group><subject>Saudi Arabia</subject></subj-group></subj-group></subj-group></subj-group></article-categories><title-group><article-title>A Comparative Study of Clinical Presentation and Risk Factors for Adverse Outcome in Patients Hospitalised with Acute Respiratory Disease Due to MERS Coronavirus or Other Causes</article-title><alt-title alt-title-type="running-head">Comparative Study of MERS and Other Acute Respiratory Diseases</alt-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Garbati</surname><given-names>Musa A.</given-names></name><xref ref-type="aff" rid="aff001"><sup>1</sup></xref></contrib><contrib contrib-type="author"><name><surname>Fagbo</surname><given-names>Shamsudeen F.</given-names></name><xref ref-type="aff" rid="aff001"><sup>1</sup></xref></contrib><contrib contrib-type="author"><name><surname>Fang</surname><given-names>Vicky J.</given-names></name><xref ref-type="aff" rid="aff002"><sup>2</sup></xref></contrib><contrib contrib-type="author"><name><surname>Skakni</surname><given-names>Leila</given-names></name><xref ref-type="aff" rid="aff001"><sup>1</sup></xref></contrib><contrib contrib-type="author"><name><surname>Joseph</surname><given-names>Mercy</given-names></name><xref ref-type="aff" rid="aff001"><sup>1</sup></xref></contrib><contrib contrib-type="author"><name><surname>Wani</surname><given-names>Tariq A.</given-names></name><xref ref-type="aff" rid="aff001"><sup>1</sup></xref></contrib><contrib contrib-type="author"><name><surname>Cowling</surname><given-names>Benjamin J.</given-names></name><xref ref-type="aff" rid="aff002"><sup>2</sup></xref></contrib><contrib contrib-type="author"><name><surname>Peiris</surname><given-names>Malik</given-names></name><xref ref-type="aff" rid="aff002"><sup>2</sup></xref><xref ref-type="corresp" rid="cor001">*</xref></contrib><contrib contrib-type="author"><name><surname>Hakawi</surname><given-names>Ahmed</given-names></name><xref ref-type="aff" rid="aff001"><sup>1</sup></xref><xref ref-type="corresp" rid="cor001">*</xref></contrib></contrib-group><aff id="aff001"><label>1</label><addr-line>King Fahad Medical City, Riyadh, Saudi Arabia</addr-line></aff><aff id="aff002"><label>2</label><addr-line>School of Public Health, The University of Hong Kong, Hong Kong SAR</addr-line></aff><contrib-group><contrib contrib-type="editor"><name><surname>Chan</surname><given-names>Renee W.Y.</given-names></name><role>Editor</role><xref ref-type="aff" rid="edit1"></xref></contrib></contrib-group><aff id="edit1"><addr-line>Chinese University of Hong Kong, HONG KONG</addr-line></aff><author-notes><fn fn-type="COI-statement" id="coi001"><p><bold>Competing Interests: </bold>The authors have declared that no competing interests exist.</p></fn><fn fn-type="con"><p><list list-type="simple"><list-item><p><bold>Conceptualization:</bold> MAG SFF AH.</p></list-item><list-item><p><bold>Data curation:</bold> SFF VJF.</p></list-item><list-item><p><bold>Formal analysis:</bold> TAW SFF MAG VJF BJC MP.</p></list-item><list-item><p><bold>Funding acquisition:</bold> MP AH.</p></list-item><list-item><p><bold>Investigation:</bold> MAG SFF LS MJ.</p></list-item><list-item><p><bold>Methodology:</bold> SFF MAG VJF BJC AH.</p></list-item><list-item><p><bold>Project administration:</bold> AH MP.</p></list-item><list-item><p><bold>Resources:</bold> LS MJ AH MAG.</p></list-item><list-item><p><bold>Software:</bold> TAW VJF.</p></list-item><list-item><p><bold>Supervision:</bold> AH MAG SFF MP LS.</p></list-item><list-item><p><bold>Validation:</bold> MAG SFF.</p></list-item><list-item><p><bold>Visualization:</bold> VJF MAG SFF.</p></list-item><list-item><p><bold>Writing – original draft:</bold> MAG SSF MP.</p></list-item><list-item><p><bold>Writing – review & editing:</bold> SFF MAG AH MP.</p></list-item></list></p></fn><corresp id="cor001">* E-mail: <email>ahakawi@kfmc.med.sa</email> (AH); <email>malik@hku.hk</email> (MP)</corresp></author-notes><pub-date pub-type="epub"><day>3</day><month>11</month><year>2016</year></pub-date><pub-date pub-type="collection"><year>2016</year></pub-date><volume>11</volume><issue>11</issue><elocation-id>e0165978</elocation-id><history><date date-type="received"><day>12</day><month>8</month><year>2016</year></date><date date-type="accepted"><day>20</day><month>10</month><year>2016</year></date></history><permissions><copyright-statement>© 2016 Garbati et al</copyright-statement><copyright-year>2016</copyright-year><copyright-holder>Garbati et al</copyright-holder><license xlink:href="http://creativecommons.org/licenses/by/4.0/"><license-p>This is an open access article distributed under the terms of the <ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/licenses/by/4.0/">Creative Commons Attribution License</ext-link>, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.</license-p></license></permissions><self-uri content-type="pdf" xlink:href="pone.0165978.pdf"></self-uri><abstract><p>Middle East Respiratory syndrome (MERS) first emerged in Saudi Arabia in 2012 and remains a global health concern. The objective of this study was to compare the clinical features and risk factors for adverse outcome in patients with RT-PCR confirmed MERS and in those with acute respiratory disease who were MERS-CoV negative, presenting to the King Fahad Medical City (KFMC) in Riyadh between October 2012 and May 2014. The demographics, clinical and laboratory characteristics and clinical outcomes of patients with RT-PCR confirmed MERS-CoV infection was compared with those testing negative MERS-CoV PCR. Health care workers (HCW) with MERS were compared with MERS patients who were not health care workers. One hundred and fifty nine patients were eligible for inclusion. Forty eight tested positive for MERS CoV, 44 (92%) being hospital acquired infections and 23 were HCW. There were 111 MERS-CoV negative patients with acute respiratory illnesses included in this study as “negative controls”. Patient with confirmed MERS-CoV infection were not clinically distinguishable from those with negative MERS-CoV RT-PCR results although diarrhoea was commoner in MERS patients. A high level of suspicion in initiating laboratory tests for MERS-CoV is therefore indicated. Variables associated with adverse outcome were older age and diabetes as a co-morbid illness. Interestingly, co-morbid illnesses other than diabetes were not significantly associated with poor outcome. Health care workers with MERS had a markedly better clinical outcome compared to non HCW MERS patients.</p></abstract><funding-group><award-group id="award001"><funding-source><institution>National Institute of Allergy and Infectious Diseases, National Institutes of Health, Department of Health and Human Services</institution></funding-source><award-id>HHSN272201400006C</award-id><principal-award-recipient><name><surname>Peiris</surname><given-names>Malik</given-names></name></principal-award-recipient></award-group><funding-statement>This work was funded by the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Department of Health and Human Services, under contract number HHSN272201400006C.</funding-statement></funding-group><counts><fig-count count="2"></fig-count><table-count count="7"></table-count><page-count count="12"></page-count></counts><custom-meta-group><custom-meta id="data-availability"><meta-name>Data Availability</meta-name><meta-value>Data are available from Dr Ahmed Hakawi, subject to criteria for protection of patient and personal privacy.</meta-value></custom-meta></custom-meta-group></article-meta><notes><title>Data Availability</title><p>Data are available from Dr Ahmed Hakawi, subject to criteria for protection of patient and personal privacy.</p></notes></front></pmc><affiliations><list><country><li>Arabie saoudite</li></country></list><tree><noCountry><name sortKey="Cowling, Benjamin J" sort="Cowling, Benjamin J" uniqKey="Cowling B" first="Benjamin J." last="Cowling">Benjamin J. Cowling</name><name sortKey="Fang, Vicky J" sort="Fang, Vicky J" uniqKey="Fang V" first="Vicky J." last="Fang">Vicky J. Fang</name><name sortKey="Peiris, Malik" sort="Peiris, Malik" uniqKey="Peiris M" first="Malik" last="Peiris">Malik Peiris</name></noCountry><country name="Arabie saoudite"><noRegion><name sortKey="Garbati, Musa A" sort="Garbati, Musa A" uniqKey="Garbati M" first="Musa A." last="Garbati">Musa A. Garbati</name></noRegion><name sortKey="Fagbo, Shamsudeen F" sort="Fagbo, Shamsudeen F" uniqKey="Fagbo S" first="Shamsudeen F." last="Fagbo">Shamsudeen F. Fagbo</name><name sortKey="Hakawi, Ahmed" sort="Hakawi, Ahmed" uniqKey="Hakawi A" first="Ahmed" last="Hakawi">Ahmed Hakawi</name><name sortKey="Joseph, Mercy" sort="Joseph, Mercy" uniqKey="Joseph M" first="Mercy" last="Joseph">Mercy Joseph</name><name sortKey="Skakni, Leila" sort="Skakni, Leila" uniqKey="Skakni L" first="Leila" last="Skakni">Leila Skakni</name><name sortKey="Wani, Tariq A" sort="Wani, Tariq A" uniqKey="Wani T" first="Tariq A." last="Wani">Tariq A. Wani</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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