Initial viral load and the outcomes of SARS
Identifieur interne : 005280 ( Main/Exploration ); précédent : 005279; suivant : 005281Initial viral load and the outcomes of SARS
Auteurs : Chung-Ming Chu ; Leo L. M. Poon ; Vincent C. C. Cheng ; Kin-Sang Chan ; Ivan F. N. Hung ; Maureen M. L. Wong ; Kwok-Hung Chan ; Wah-Shing Leung ; Bone S. F. Tang ; Veronica L. Chan ; Woon-Leung Ng ; Tiong-Chee Sim ; Ping-Wing Ng ; Kin-Ip Law ; Doris M. W. Tse ; Joseph S. M. Peiris ; Kwok-Yung YuenSource :
- CMAJ : Canadian Medical Association Journal [ 0820-3946 ] ; 2004.
Descripteurs français
- KwdFr :
- ARN viral (analyse), Adulte, Adulte d'âge moyen, Analyse de survie, Analyse multivariée, Charge virale, Comorbidité, Facteurs de l'âge, Femelle, Hong Kong (épidémiologie), Humains, Modèles de hasards proportionnels, Mâle, Partie nasale du pharynx (virologie), Sujet âgé, Sujet âgé de 80 ans ou plus, Syndrome respiratoire aigu sévère (mortalité), Syndrome respiratoire aigu sévère (sang), Syndrome respiratoire aigu sévère (virologie), Virus du SRAS (isolement et purification), Études prospectives.
- MESH :
- analyse : ARN viral.
- isolement et purification : Virus du SRAS.
- mortalité : Syndrome respiratoire aigu sévère.
- sang : Syndrome respiratoire aigu sévère.
- virologie : Partie nasale du pharynx, Syndrome respiratoire aigu sévère.
- épidémiologie : Hong Kong.
- Adulte, Adulte d'âge moyen, Analyse de survie, Analyse multivariée, Charge virale, Comorbidité, Facteurs de l'âge, Femelle, Humains, Modèles de hasards proportionnels, Mâle, Sujet âgé, Sujet âgé de 80 ans ou plus, Études prospectives.
- Wicri :
- geographic : Hong Kong.
English descriptors
- KwdEn :
- Adult, Age Factors, Aged, Aged, 80 and over, Comorbidity, Female, Hong Kong (epidemiology), Humans, Male, Middle Aged, Multivariate Analysis, Nasopharynx (virology), Proportional Hazards Models, Prospective Studies, RNA, Viral (analysis), SARS Virus (isolation & purification), Severe Acute Respiratory Syndrome (blood), Severe Acute Respiratory Syndrome (mortality), Severe Acute Respiratory Syndrome (virology), Survival Analysis, Viral Load.
- MESH :
- chemical , analysis : RNA, Viral.
- geographic , epidemiology : Hong Kong.
- blood : Severe Acute Respiratory Syndrome.
- isolation & purification : SARS Virus.
- mortality : Severe Acute Respiratory Syndrome.
- virology : Nasopharynx, Severe Acute Respiratory Syndrome.
- Adult, Age Factors, Aged, Aged, 80 and over, Comorbidity, Female, Humans, Male, Middle Aged, Multivariate Analysis, Proportional Hazards Models, Prospective Studies, Survival Analysis, Viral Load.
Abstract
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.
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).
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 log10 increase in number of RNA copies per millilitre, 95% CI 1.06–1.39).
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, comorbidity and viral load. These considerations will be important in future studies of SARS.
Url:
DOI: 10.1503/cmaj.1040398
PubMed: 15557587
PubMed Central: 527336
Affiliations:
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M." last="Poon">Leo L. M. Poon</name></author><author><name sortKey="Cheng, Vincent C C" sort="Cheng, Vincent C C" uniqKey="Cheng V" first="Vincent C. C." last="Cheng">Vincent C. C. Cheng</name></author><author><name sortKey="Chan, Kin Sang" sort="Chan, Kin Sang" uniqKey="Chan K" first="Kin-Sang" last="Chan">Kin-Sang Chan</name></author><author><name sortKey="Hung, Ivan F N" sort="Hung, Ivan F N" uniqKey="Hung I" first="Ivan F. N." last="Hung">Ivan F. N. Hung</name></author><author><name sortKey="Wong, Maureen M L" sort="Wong, Maureen M L" uniqKey="Wong M" first="Maureen M. L." last="Wong">Maureen M. L. Wong</name></author><author><name sortKey="Chan, Kwok Hung" sort="Chan, Kwok Hung" uniqKey="Chan K" first="Kwok-Hung" last="Chan">Kwok-Hung Chan</name></author><author><name sortKey="Leung, Wah Shing" sort="Leung, Wah Shing" uniqKey="Leung W" first="Wah-Shing" last="Leung">Wah-Shing Leung</name></author><author><name sortKey="Tang, Bone S F" sort="Tang, Bone S F" uniqKey="Tang B" first="Bone S. F." last="Tang">Bone S. F. Tang</name></author><author><name sortKey="Chan, Veronica L" sort="Chan, Veronica L" uniqKey="Chan V" first="Veronica L." last="Chan">Veronica L. Chan</name></author><author><name sortKey="Ng, Woon Leung" sort="Ng, Woon Leung" uniqKey="Ng W" first="Woon-Leung" last="Ng">Woon-Leung Ng</name></author><author><name sortKey="Sim, Tiong Chee" sort="Sim, Tiong Chee" uniqKey="Sim T" first="Tiong-Chee" last="Sim">Tiong-Chee Sim</name></author><author><name sortKey="Ng, Ping Wing" sort="Ng, Ping Wing" uniqKey="Ng P" first="Ping-Wing" last="Ng">Ping-Wing Ng</name></author><author><name sortKey="Law, Kin Ip" sort="Law, Kin Ip" uniqKey="Law K" first="Kin-Ip" last="Law">Kin-Ip Law</name></author><author><name sortKey="Tse, Doris M W" sort="Tse, Doris M W" uniqKey="Tse D" first="Doris M. W." last="Tse">Doris M. W. Tse</name></author><author><name sortKey="Peiris, Joseph S M" sort="Peiris, Joseph S M" uniqKey="Peiris J" first="Joseph S. M." last="Peiris">Joseph S. M. Peiris</name></author><author><name sortKey="Yuen, Kwok Yung" sort="Yuen, Kwok Yung" uniqKey="Yuen K" first="Kwok-Yung" last="Yuen">Kwok-Yung Yuen</name></author></analytic><series><title level="j">CMAJ : Canadian Medical Association Journal</title><idno type="ISSN">0820-3946</idno><idno type="eISSN">1488-2329</idno><imprint><date when="2004">2004</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Adult</term><term>Age Factors</term><term>Aged</term><term>Aged, 80 and over</term><term>Comorbidity</term><term>Female</term><term>Hong Kong (epidemiology)</term><term>Humans</term><term>Male</term><term>Middle Aged</term><term>Multivariate Analysis</term><term>Nasopharynx (virology)</term><term>Proportional Hazards Models</term><term>Prospective Studies</term><term>RNA, Viral (analysis)</term><term>SARS Virus (isolation & purification)</term><term>Severe Acute Respiratory Syndrome (blood)</term><term>Severe Acute Respiratory Syndrome (mortality)</term><term>Severe Acute Respiratory Syndrome (virology)</term><term>Survival Analysis</term><term>Viral Load</term></keywords><keywords scheme="KwdFr" xml:lang="fr"><term>ARN viral (analyse)</term><term>Adulte</term><term>Adulte d'âge moyen</term><term>Analyse de survie</term><term>Analyse multivariée</term><term>Charge virale</term><term>Comorbidité</term><term>Facteurs de l'âge</term><term>Femelle</term><term>Hong Kong (épidémiologie)</term><term>Humains</term><term>Modèles de hasards proportionnels</term><term>Mâle</term><term>Partie nasale du pharynx (virologie)</term><term>Sujet âgé</term><term>Sujet âgé de 80 ans ou plus</term><term>Syndrome respiratoire aigu sévère (mortalité)</term><term>Syndrome respiratoire aigu sévère (sang)</term><term>Syndrome respiratoire aigu sévère (virologie)</term><term>Virus du SRAS (isolement et purification)</term><term>Études prospectives</term></keywords><keywords scheme="MESH" type="chemical" qualifier="analysis" xml:lang="en"><term>RNA, Viral</term></keywords><keywords scheme="MESH" type="geographic" qualifier="epidemiology" xml:lang="en"><term>Hong Kong</term></keywords><keywords scheme="MESH" qualifier="analyse" xml:lang="fr"><term>ARN viral</term></keywords><keywords scheme="MESH" qualifier="blood" xml:lang="en"><term>Severe Acute Respiratory Syndrome</term></keywords><keywords scheme="MESH" qualifier="isolation & purification" xml:lang="en"><term>SARS Virus</term></keywords><keywords scheme="MESH" qualifier="isolement et purification" xml:lang="fr"><term>Virus du SRAS</term></keywords><keywords scheme="MESH" qualifier="mortality" xml:lang="en"><term>Severe Acute Respiratory Syndrome</term></keywords><keywords scheme="MESH" qualifier="mortalité" xml:lang="fr"><term>Syndrome respiratoire aigu sévère</term></keywords><keywords scheme="MESH" qualifier="sang" xml:lang="fr"><term>Syndrome respiratoire aigu sévère</term></keywords><keywords scheme="MESH" qualifier="virologie" xml:lang="fr"><term>Partie nasale du pharynx</term><term>Syndrome respiratoire aigu sévère</term></keywords><keywords scheme="MESH" qualifier="virology" xml:lang="en"><term>Nasopharynx</term><term>Severe Acute Respiratory Syndrome</term></keywords><keywords scheme="MESH" qualifier="épidémiologie" xml:lang="fr"><term>Hong Kong</term></keywords><keywords scheme="MESH" xml:lang="en"><term>Adult</term><term>Age Factors</term><term>Aged</term><term>Aged, 80 and over</term><term>Comorbidity</term><term>Female</term><term>Humans</term><term>Male</term><term>Middle Aged</term><term>Multivariate Analysis</term><term>Proportional Hazards Models</term><term>Prospective Studies</term><term>Survival Analysis</term><term>Viral Load</term></keywords><keywords scheme="MESH" xml:lang="fr"><term>Adulte</term><term>Adulte d'âge moyen</term><term>Analyse de survie</term><term>Analyse multivariée</term><term>Charge virale</term><term>Comorbidité</term><term>Facteurs de l'âge</term><term>Femelle</term><term>Humains</term><term>Modèles de hasards proportionnels</term><term>Mâle</term><term>Sujet âgé</term><term>Sujet âgé de 80 ans ou plus</term><term>Études prospectives</term></keywords><keywords scheme="Wicri" type="geographic" xml:lang="fr"><term>Hong Kong</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Background</title><p>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.</p></sec><sec><title>Methods</title><p>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).</p></sec><sec><title>Results</title><p>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<sub>10</sub> increase in number of RNA copies per millilitre, 95% CI 1.06–1.39).</p></sec><sec><title>Interpretation</title><p>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, comorbidity and viral load. These considerations will be important in future studies of SARS.</p></sec></div></front></TEI><affiliations><list></list><tree><noCountry><name sortKey="Chan, Kin Sang" sort="Chan, Kin Sang" uniqKey="Chan K" first="Kin-Sang" last="Chan">Kin-Sang Chan</name><name sortKey="Chan, Kwok Hung" sort="Chan, Kwok Hung" uniqKey="Chan K" first="Kwok-Hung" last="Chan">Kwok-Hung Chan</name><name sortKey="Chan, Veronica L" sort="Chan, Veronica L" uniqKey="Chan V" first="Veronica L." last="Chan">Veronica L. Chan</name><name sortKey="Cheng, Vincent C C" sort="Cheng, Vincent C C" uniqKey="Cheng V" first="Vincent C. C." last="Cheng">Vincent C. C. Cheng</name><name sortKey="Chu, Chung Ming" sort="Chu, Chung Ming" uniqKey="Chu C" first="Chung-Ming" last="Chu">Chung-Ming Chu</name><name sortKey="Hung, Ivan F N" sort="Hung, Ivan F N" uniqKey="Hung I" first="Ivan F. N." last="Hung">Ivan F. N. Hung</name><name sortKey="Law, Kin Ip" sort="Law, Kin Ip" uniqKey="Law K" first="Kin-Ip" last="Law">Kin-Ip Law</name><name sortKey="Leung, Wah Shing" sort="Leung, Wah Shing" uniqKey="Leung W" first="Wah-Shing" last="Leung">Wah-Shing Leung</name><name sortKey="Ng, Ping Wing" sort="Ng, Ping Wing" uniqKey="Ng P" first="Ping-Wing" last="Ng">Ping-Wing Ng</name><name sortKey="Ng, Woon Leung" sort="Ng, Woon Leung" uniqKey="Ng W" first="Woon-Leung" last="Ng">Woon-Leung Ng</name><name sortKey="Peiris, Joseph S M" sort="Peiris, Joseph S M" uniqKey="Peiris J" first="Joseph S. M." last="Peiris">Joseph S. M. Peiris</name><name sortKey="Poon, Leo L M" sort="Poon, Leo L M" uniqKey="Poon L" first="Leo L. M." last="Poon">Leo L. M. Poon</name><name sortKey="Sim, Tiong Chee" sort="Sim, Tiong Chee" uniqKey="Sim T" first="Tiong-Chee" last="Sim">Tiong-Chee Sim</name><name sortKey="Tang, Bone S F" sort="Tang, Bone S F" uniqKey="Tang B" first="Bone S. F." last="Tang">Bone S. F. Tang</name><name sortKey="Tse, Doris M W" sort="Tse, Doris M W" uniqKey="Tse D" first="Doris M. W." last="Tse">Doris M. W. Tse</name><name sortKey="Wong, Maureen M L" sort="Wong, Maureen M L" uniqKey="Wong M" first="Maureen M. L." last="Wong">Maureen M. L. Wong</name><name sortKey="Yuen, Kwok Yung" sort="Yuen, Kwok Yung" uniqKey="Yuen K" first="Kwok-Yung" last="Yuen">Kwok-Yung Yuen</name></noCountry></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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