Outcome of coronavirus‐associated severe acute respiratory syndrome using a standard treatment protocol
Identifieur interne : 000250 ( Psycho/Analysis ); précédent : 000249; suivant : 000251Outcome of coronavirus‐associated severe acute respiratory syndrome using a standard treatment protocol
Auteurs : Arthur Chun-Wing Lau ; Loletta Kit-Ying So ; Flora Pui-Ling Miu ; Raymond Wai-Hung Yung [République populaire de Chine] ; Edwin Poon ; Thomas Man-Tat Cheung ; Loretta Yin-Chun YamSource :
- Respirology [ 1323-7799 ] ; 2004-06.
English descriptors
- Teeft :
- Additional therapy, Antibiotic, Clinical criteria, Clinical information, Clinical stabilization, Cohort study, Combination therapy, Combination treatment, Continuous variables, Convalescent sera, Coronavirus, Corticosteroid, Corticosteroid regimen, Creatinine level, Critical care medicine, Disease control, Hong kong, Independent predictor, Independent predictors, Invasive ventilation, Laboratory diagnosis, Mechanical ventilation, Median, Methylprednisolone, Methylprednisolone rescue, Methylprednisolone therapy, Mycoplasma pneumoniae, Nasopharyngeal, Nasopharyngeal aspirate, Nasopharyngeal samples, Nethersole, Novel coronavirus, Other hospital, Oxygen saturation, Oxygen supplementation, Oxygen therapy, Pamela youde nethersole, Pneumocystis carinii pneumonia, Pneumonia, Possible sepsis, Predictor, Present study, Probable cases, Protocol, Psychiatric manifestations, Regimen, Respiratory distress syndrome, Respiratory failure, Respiratory syndrome, Ribavirin, Sars, Sars patients, Sars table, Second course, Stabilization, Standard protocol, Standard regimens, Standard treatment protocol, Steroid, Steroid commencement, Subcutaneous emphysema, Symptom onset, Syndrome, Ventilatorassociated pneumonia, Viral load, World health organization, Youde.
Abstract
Objective: There is so far no consensus on the optimal treatment strategy for the coronavirus‐associated severe acute respiratory syndrome (SARS). We aimed to analyse the outcomes of a standard treatment strategy comprising antibiotics, a combination of ribavirin, a 3‐week step‐down course of corticosteroids, and the possibility of pulsed methylprednisolone rescue in the event of deterioration. Methodology: This was a prospective cohort study performed at a major public‐funded hospital in Hong Kong. Eighty‐eight World Health Organisation/Centers for Disease Control and Prevention probable cases of SARS (97% laboratory‐confirmed) were treated with a standard protocol previously reported. Seventy‐one patients treated de novo were analysed in detail with regard to time to clinical stabilization after combination treatment, requirement of additional therapy (pulsed methylprednisolone; assisted ventilation); and final outcomes (recovery, mortality). Results: The mean age was 42. Twenty‐one patients (24%) had comorbidities. Three of 71 treated de novo recovered with antibiotics alone. The remaining 68 received combination treatment at a mean of 5.8 days after symptom onset, of whom 30 subsequently required pulsed methylprednisolone rescue (independent predictors: older age and higher LDH) and 18 required assisted ventilation (independent predictors: older age, higher oxygen requirement and creatinine level). Their median time to clinical stabilization was 8.0 days after combination treatment (independent predictor for longer time to stabilization: median age of 41 or above). Common complications were hyperglycaemia (58%), pneumo‐mediastinum/thoraces (13%), psychiatric manifestations (7%) and ventilator‐associated pneumonia (2%). One patient (1%) died of SARS‐related respiratory failure. All‐cause mortality was 3.4%, occurring in patients aged > 65 years only. None of the discharged survivors required continuation of oxygen therapy. Conclusions: This standard treatment protocol resulted in overall satisfactory outcomes. Randomized controlled trial is suggested to confirm its efficacy.
Url:
DOI: 10.1111/j.1440-1843.2004.00588.x
Affiliations:
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<term>Oxygen supplementation</term>
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<front><div type="abstract" xml:lang="en">Objective: There is so far no consensus on the optimal treatment strategy for the coronavirus‐associated severe acute respiratory syndrome (SARS). We aimed to analyse the outcomes of a standard treatment strategy comprising antibiotics, a combination of ribavirin, a 3‐week step‐down course of corticosteroids, and the possibility of pulsed methylprednisolone rescue in the event of deterioration. Methodology: This was a prospective cohort study performed at a major public‐funded hospital in Hong Kong. Eighty‐eight World Health Organisation/Centers for Disease Control and Prevention probable cases of SARS (97% laboratory‐confirmed) were treated with a standard protocol previously reported. Seventy‐one patients treated de novo were analysed in detail with regard to time to clinical stabilization after combination treatment, requirement of additional therapy (pulsed methylprednisolone; assisted ventilation); and final outcomes (recovery, mortality). Results: The mean age was 42. Twenty‐one patients (24%) had comorbidities. Three of 71 treated de novo recovered with antibiotics alone. The remaining 68 received combination treatment at a mean of 5.8 days after symptom onset, of whom 30 subsequently required pulsed methylprednisolone rescue (independent predictors: older age and higher LDH) and 18 required assisted ventilation (independent predictors: older age, higher oxygen requirement and creatinine level). Their median time to clinical stabilization was 8.0 days after combination treatment (independent predictor for longer time to stabilization: median age of 41 or above). Common complications were hyperglycaemia (58%), pneumo‐mediastinum/thoraces (13%), psychiatric manifestations (7%) and ventilator‐associated pneumonia (2%). One patient (1%) died of SARS‐related respiratory failure. All‐cause mortality was 3.4%, occurring in patients aged > 65 years only. None of the discharged survivors required continuation of oxygen therapy. Conclusions: This standard treatment protocol resulted in overall satisfactory outcomes. Randomized controlled trial is suggested to confirm its efficacy.</div>
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