Adverse Effects of Ribavirin and Outcome in Severe Acute Respiratory Syndrome
Identifieur interne : 004C62 ( Main/Merge ); précédent : 004C61; suivant : 004C63Adverse Effects of Ribavirin and Outcome in Severe Acute Respiratory Syndrome
Auteurs : Hsueh-Erh Chiou [Taïwan] ; Ching-Lung Liu [Taïwan] ; Mary Jeanne Buttrey [Taïwan] ; Han-Pin Kuo [Taïwan] ; Hui-Wen Liu [Taïwan] ; Hsu-Tah Kuo [Taïwan] ; Yen-Ta Lu [Taïwan]Source :
- Chest [ 0012-3692 ] ; 2005.
Abstract
To assess the effect of ribavirin-induced anemia on the outcome of severe acute respiratory syndrome (SARS).
A retrospective observational study.
Two medical centers in Taiwan.
Forty-four patients with SARS who received ribavirin and 7 patients with SARS who did not receive ribavirin.
The mean peak C-reactive protein and lactate dehydrogenase levels were higher in SARS patients who were receiving ribavirin therapy than in SARS patients who were not receiving ribavirin therapy. The mortality was also higher, but the difference was not statistically significant. On multivariate analysis, hemoglobin level was an independent prognostic correlate of hypoxemia or mortality (odds ratio, 2.0; 95% confidence interval, 1.1 to 3.8; p = 0.03). The hemoglobin began decreasing in two thirds of SARS patients (32 of 44 patients; 73%) who were receiving ribavirin 3 days after therapy with the antiviral drug was started. Patients with a drop in hemoglobin level of > 2 g/dL had a significantly higher mortality rate than the other patients. Hypoxemia developed in one third of SARS patients (17 of 44 patients; 39%) who were receiving ribavirin, all of whom were anemic. Of the 17 hypoxemic patients, 11 (65%) had a drop in hemoglobin of > 2 g/dL, and 4 patients (24%) required a blood transfusion. The mean slope of the hemoglobin decrease was significantly steeper (p = 0.001) in hypoxemic patients with SARS who were receiving ribavirin than in the nonhypoxemic patients with SARS who were receiving ribavirin. Only one of seven SARS patients (14%) who was not receiving ribavirin became anemic, but this individual was not hypoxemic. Eventually, 5 of 17 hypoxemic and anemic SARS patients (29%) who were receiving ribavirin died. The combination of hypoxia with anemia was thus significantly associated with a higher mortality (p < 0.001).
Hypoxia combined with anemia increased the risk for death in SARS patients. Unless ribavirin can be shown to be effective against SARS-coronavirus, the risk of anemia posed by this drug argues against its use in SARS patients.
Url:
DOI: 10.1378/chest.128.1.263
PubMed: 16002945
PubMed Central: 7094379
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Hospital, Taipei, Taiwan</nlm:aff><country xml:lang="fr">Taïwan</country><wicri:regionArea>Pharmacy Department, Mackay Memorial Hospital, Taipei</wicri:regionArea><wicri:noRegion>Taipei</wicri:noRegion></affiliation></author><author><name sortKey="Liu, Ching Lung" sort="Liu, Ching Lung" uniqKey="Liu C" first="Ching-Lung" last="Liu">Ching-Lung Liu</name><affiliation wicri:level="1"><nlm:aff id="aff2">Division of Chest Medicine, Department of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan</nlm:aff><country xml:lang="fr">Taïwan</country><wicri:regionArea>Division of Chest Medicine, Department of Internal Medicine, Mackay Memorial Hospital, Taipei</wicri:regionArea><wicri:noRegion>Taipei</wicri:noRegion></affiliation></author><author><name sortKey="Buttrey, Mary Jeanne" sort="Buttrey, Mary Jeanne" uniqKey="Buttrey M" first="Mary Jeanne" last="Buttrey">Mary Jeanne Buttrey</name><affiliation wicri:level="1"><nlm:aff id="aff3">Department of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan</nlm:aff><country xml:lang="fr">Taïwan</country><wicri:regionArea>Department of Internal Medicine, Mackay Memorial Hospital, Taipei</wicri:regionArea><wicri:noRegion>Taipei</wicri:noRegion></affiliation></author><author><name sortKey="Kuo, Han Pin" sort="Kuo, Han Pin" uniqKey="Kuo H" first="Han-Pin" last="Kuo">Han-Pin Kuo</name><affiliation wicri:level="1"><nlm:aff id="aff2">Division of Chest Medicine, Department of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan</nlm:aff><country xml:lang="fr">Taïwan</country><wicri:regionArea>Division of Chest Medicine, Department of Internal Medicine, Mackay Memorial Hospital, Taipei</wicri:regionArea><wicri:noRegion>Taipei</wicri:noRegion></affiliation></author><author><name sortKey="Liu, Hui Wen" sort="Liu, Hui Wen" uniqKey="Liu H" first="Hui-Wen" last="Liu">Hui-Wen Liu</name><affiliation wicri:level="1"><nlm:aff id="aff1">Pharmacy Department, Mackay Memorial Hospital, Taipei, Taiwan</nlm:aff><country xml:lang="fr">Taïwan</country><wicri:regionArea>Pharmacy Department, Mackay Memorial Hospital, Taipei</wicri:regionArea><wicri:noRegion>Taipei</wicri:noRegion></affiliation></author><author><name sortKey="Kuo, Hsu Tah" sort="Kuo, Hsu Tah" uniqKey="Kuo H" first="Hsu-Tah" last="Kuo">Hsu-Tah Kuo</name><affiliation wicri:level="1"><nlm:aff id="aff2">Division of Chest Medicine, Department of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan</nlm:aff><country xml:lang="fr">Taïwan</country><wicri:regionArea>Division of Chest Medicine, Department of Internal Medicine, Mackay Memorial Hospital, Taipei</wicri:regionArea><wicri:noRegion>Taipei</wicri:noRegion></affiliation><affiliation><nlm:aff>NONE</nlm:aff></affiliation></author><author><name sortKey="Lu, Yen Ta" sort="Lu, Yen Ta" uniqKey="Lu Y" first="Yen-Ta" last="Lu">Yen-Ta Lu</name><affiliation wicri:level="1"><nlm:aff id="aff4">Department of Respiratory Care, Taipei Medical University, Taipei, Taiwan</nlm:aff><country xml:lang="fr">Taïwan</country><wicri:regionArea>Department of Respiratory Care, Taipei Medical University, Taipei</wicri:regionArea><wicri:noRegion>Taipei</wicri:noRegion></affiliation></author></analytic><series><title level="j">Chest</title><idno type="ISSN">0012-3692</idno><idno type="eISSN">1931-3543</idno><imprint><date when="2005">2005</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Study objectives</title><p>To assess the effect of ribavirin-induced anemia on the outcome of severe acute respiratory syndrome (SARS).</p></sec><sec><title>Design</title><p>A retrospective observational study.</p></sec><sec><title>Setting</title><p>Two medical centers in Taiwan.</p></sec><sec><title>Patients</title><p>Forty-four patients with SARS who received ribavirin and 7 patients with SARS who did not receive ribavirin.</p></sec><sec><title>Measurements and results</title><p>The mean peak C-reactive protein and lactate dehydrogenase levels were higher in SARS patients who were receiving ribavirin therapy than in SARS patients who were not receiving ribavirin therapy. The mortality was also higher, but the difference was not statistically significant. On multivariate analysis, hemoglobin level was an independent prognostic correlate of hypoxemia or mortality (odds ratio, 2.0; 95% confidence interval, 1.1 to 3.8; p = 0.03). The hemoglobin began decreasing in two thirds of SARS patients (32 of 44 patients; 73%) who were receiving ribavirin 3 days after therapy with the antiviral drug was started. Patients with a drop in hemoglobin level of > 2 g/dL had a significantly higher mortality rate than the other patients. Hypoxemia developed in one third of SARS patients (17 of 44 patients; 39%) who were receiving ribavirin, all of whom were anemic. Of the 17 hypoxemic patients, 11 (65%) had a drop in hemoglobin of > 2 g/dL, and 4 patients (24%) required a blood transfusion. The mean slope of the hemoglobin decrease was significantly steeper (p = 0.001) in hypoxemic patients with SARS who were receiving ribavirin than in the nonhypoxemic patients with SARS who were receiving ribavirin. Only one of seven SARS patients (14%) who was not receiving ribavirin became anemic, but this individual was not hypoxemic. Eventually, 5 of 17 hypoxemic and anemic SARS patients (29%) who were receiving ribavirin died. The combination of hypoxia with anemia was thus significantly associated with a higher mortality (p < 0.001).</p></sec><sec><title>Conclusions</title><p>Hypoxia combined with anemia increased the risk for death in SARS patients. 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