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Severe acute respiratory syndrome: report of treatment and outcome after a major outbreak
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  1. J J Y Sung1,
  2. A Wu1,
  3. G M Joynt2,
  4. K Y Yuen3,
  5. N Lee1,
  6. P K S Chan4,
  7. C S Cockram1,
  8. A T Ahuja5,
  9. L M Yu6,
  10. V W Wong1,
  11. D S C Hui1
  1. 1Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong
  2. 2Department of Anesthesia and Intensive Care, The Chinese University of Hong Kong, Hong Kong
  3. 3Department of Microbiology, The University of Hong Kong, Hong Kong
  4. 4Department of Microbiology, The Chinese University of Hong Kong, Hong Kong
  5. 5Department of Diagnostic Radiology and Organ Imaging, The Chinese University of Hong Kong, Hong Kong
  6. 6Center for Clinical Trial and Epidemiological Research, The Chinese University of Hong Kong, Hong Kong
  1. Correspondence to:
    Dr D S C Hui
    Department of Medicine and Therapeutics, Prince of Wales Hospital, Shatin, NT, Hong Kong; dschuicuhk.edu.hk

Abstract

Background: The outcome is reported of a prospective uncontrolled study based on a stepwise treatment protocol during an outbreak of severe acute respiratory syndrome (SARS) in Hong Kong.

Method: One hundred and thirty eight patients were treated with broad spectrum antibiotics, a combination of ribavirin and low dose corticosteroid, and then intravenous high dose methylprednisolone according to responses. Sustained response to treatment was defined as (1) defervescence for ⩾4 consecutive days, (2) resolution of lung consolidation by >25%, and (3) oxygen independence by the fourth day without fever. Patients with defervescence who achieved either criterion 2 or 3 were classified as partial responders. Patients who fell short of criteria 2 and 3 were non-responders.

Results: Laboratory confirmation of SARS coronavirus infection was established in 132 (95.7%). None responded to antibiotics but 25 (18.1%) responded to ribavirin + low dose corticosteroid. Methylprednisolone was used in 107 patients, of whom 95 (88.8%) responded favourably. Evidence of haemolytic anaemia was observed in 49 (36%). A high level of C-reactive protein at presentation was the only independent predictor for use of methylprednisolone (odds ratio 2.18 per 10 mg/dl increase, 95% confidence interval 1.12 to 4.25, p = 0.02). Thirty seven patients (26.8%) required admission to the intensive care unit and 21 (15.2%) required invasive mechanical ventilation. There were 15 deaths (mortality rate 10.9%), most with significant co-morbidities, whereas 122 (88.4%) had been discharged home 4 months after the outbreak onset.

Conclusion: The use of high dose pulse methylprednisolone during the clinical course of a SARS outbreak was associated with clinical improvement, but randomised controlled trials are needed to ascertain its efficacy in this condition.

  • severe acute respiratory syndrome (SARS)
  • ribavirin
  • treatment
  • corticosteroid
  • outcome
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