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Impact of severe acute respiratory syndrome (SARS) on pulmonary function, functional capacity and quality of life in a cohort of survivors
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  1. D S Hui1,2,
  2. G M Joynt3,
  3. K T Wong4,
  4. C D Gomersall3,
  5. T S Li3,
  6. G Antonio4,
  7. F W Ko2,
  8. M C Chan2,
  9. D P Chan2,
  10. M W Tong2,
  11. T H Rainer5,
  12. A T Ahuja4,
  13. C S Cockram1,2,
  14. J J Y Sung1,2
  1. 1Center for Emerging Infectious Diseases, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, NT, Hong Kong
  2. 2Department of Medicine and Therapeutics, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, NT, Hong Kong
  3. 3Department of Anaesthesia and Intensive Care, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, NT, Hong Kong
  4. 4Department of Diagnostic Radiology and Organ Imaging, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, NT, Hong Kong
  5. 5Accident and Emergency, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, NT, Hong Kong
  1. Correspondence to:
    Dr D S Hui
    Department of Medicine and Therapeutics, Chinese University of Hong Kong, Prince of Wales Hospital, 30–32 Ngan Shing St, Shatin, NT, Hong Kong; dschuicuhk.edu.hk

Abstract

Objective: To examine the impact of severe acute respiratory syndrome (SARS) on pulmonary function, exercise capacity, and health-related quality of life (HRQoL) among survivors.

Methods: 110 survivors with confirmed SARS were evaluated at the Prince of Wales Hospital, HK at the end of 3 and 6 months after symptom onset. The assessment included lung volumes (TLC, VC, RV, FRC), spirometry (FVC, FEV1), carbon monoxide transfer factor (Tlco adjusted for haemoglobin), inspiratory and expiratory respiratory muscle strength (Pimax and Pemax), 6 minute walk distance (6MWD), chest radiographs, and HRQoL by SF-36 questionnaire.

Results: There were 44 men and 66 women with a mean (SD) age of 35.6 (9.8) years and body mass index of 23.1 (4.8) kg/m2. Seventy (64%) were healthcare workers. At 6 months 33 subjects (30%) had abnormal chest radiographs; four (3.6%), eight (7.4%), and 17 (15.5%) patients had FVC, TLC, and Tlco below 80% of predicted values; and 15 (13.9%) and 24 (22.2%) had Pimax and Pemax values below 80 cm H2O, respectively. The 6MWD increased from a mean (SD) of 464 (83) m at 3 months to 502 (95) m (95% CI 22 to 54 m, p<0.001), but the results were lower than normal controls in the same age groups. There was impairment of HRQoL at 6 months. Patients who required ICU admission (n = 31) had significantly lower FVC, TLC, and Tlco than those who did not.

Conclusion: The exercise capacity and health status of SARS survivors was considerably lower than that of a normal population at 6 months. Significant impairment in surface area for gas exchange was noted in 15.5% of survivors. The functional disability appears out of proportion to the degree of lung function impairment and may be related to additional factors such as muscle deconditioning and steroid myopathy.

  • BMI, body mass index
  • CRP, C-reactive protein
  • FEV1, forced expiratory volume in 1 second
  • FRC, functional residual capacity
  • FVC, forced vital capacity
  • HRQoL, health-related quality of life
  • LDH, lactate dehydrogenase
  • LOS, length of stay
  • 6MWD, 6 minute walk distance
  • 6MWT, 6 minute walk test
  • Pimax, Pemax, maximum static inspiratory and expiratory pressures
  • RV, residual volume
  • SARS, severe acute respiratory syndrome
  • TLC, total lung capacity
  • Tlco, carbon monoxide transfer factor
  • severe acute respiratory syndrome (SARS)
  • lung function
  • quality of life

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Supplementary materials

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    Files in this Data Supplement:

    • [view PDF] - Table S1: Correlations of chest radiograph scores versus steroid dosage, 6MWD, and lung function test parameters at 6 months
    • [view PDF] - Table S2a: Health related quality of life (SF36) among SARS survivors (n=31)who had required ICU admission at 3 and 6 months after illness onset in comparison with Hong Kong normative data stratified into different age groups
    • [view PDF] - Table S3: Comparison of age and LDH levels during hospitalization and outcome at 6 months between patients who required invasive ventilatory support (n=6) versus those not requiring intubation in ICU

Footnotes

  • Source of funding: Research Fund for the Control of Infectious Diseases (Health, Welfare and Food Bureau, HKSAR).

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