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Research letter
Predictors of mortality in Middle East respiratory syndrome (MERS)
  1. Ki-Ho Hong1,
  2. Jae-Phil Choi2,
  3. Seon-Hui Hong3,
  4. Jeewon Lee3,
  5. Ji-Soo Kwon3,4,
  6. Sun-Mi Kim4,
  7. Se Yoon Park4,
  8. Ji-Young Rhee5,
  9. Baek-Nam Kim6,
  10. Hee Jung Choi7,
  11. Eui-Cheol Shin3,8,
  12. Hyunjoo Pai9,
  13. Su-Hyung Park3,8,
  14. Sung-Han Kim4
  1. 1 Department of Laboratory Medicine, Seoul Medical Center, Seoul, Republic of Korea
  2. 2 Department of Internal Medicine, Seoul Medical Center, Seoul, Republic of Korea
  3. 3 Biomedical Science and Engineering Interdisciplinary Program, Korea Advanced Institute of Science and Technology, Daejeon, Republic of Korea
  4. 4 Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
  5. 5 Division of Infectious Diseases, Department of Internal Medicine, Dankook University Hospital, Cheonan, Republic of Korea
  6. 6 Department of Internal Medicine, Inje University Sanggye-Paik Hospital, Seoul, Rebulic of Korea
  7. 7 Department of Internal Medicine, Ewha Womans University Hospital, Seoul, Republic of Korea
  8. 8 Graduate School of Medical Science and Engineering, Korea Advanced Institute of Science and Technology, Daejeon, Republic of Korea
  9. 9 Department of Internal Medicine, Han Yang University Hospital, Seoul, Republic of Korea
  1. Correspondence to Dr Su-Hyung Park, Laboratory of Translational Immunology and Vaccinology, Graduate School of Medical Science and Engineering, KAIST, Daejeon, 34141, Republic of Korea; park3{at}kaist.ac.kr and Dr Sung-Han Kim, Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, 388-1 Pungnap-dong, Songpa-gu, Seoul, 05505, Republic of Korea; kimsunghanmd{at}hotmail.com

Abstract

We evaluated the clinical characteristics, cytokine/chemokine concentrations, viral shedding and antibody kinetics in 30 patients with Middle East respiratory syndrome (MERS), including 6 non-survivors admitted to 3 MERS-designated hospitals. Old age, low albumin, altered mentality and high pneumonia severity index score at admission were risk factors for mortality. In addition, severe signs of inflammation at initial presentation (at hospital days 1-4), such as high inducible protein-10 (p=0.0013), monocyte chemoattractant protein-1 (p=0.0007) and interleukin 6 (p=0.0007) concentrations, and poor viral control (high viral load at hospital days 5–10, p<0.001) without adequate antibody titres (low antibody titre at hospital days 11–16, p=0.07) during the course of disease, were associated with mortality.

  • viral infection
  • respiratory infection
  • infection control

https://doi.org/10.1136/thoraxjnl-2016-209313

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    Footnotes

    • K-HH, J-PC and S-HH contributed equally.

    • Contributors Conception and design: J-PC, HJC, E-CS, HP, S-HP, S-HK. Analysis and interpretation: K-HH, J-PC, E-CS, S-HP, S-HK. Data collection: K-HH, J-PC, S-HH, JL, J-SK, S-MK, SYP, J-YR, B-NK, S-HP, S-HK. Drafting the manuscript for important intellectual content: K-HH, E-CS, S-HP, S-HK.

    • Funding This study was supported by grants from the Korea Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI), funded by the Ministry of Health & Welfare, Republic of Korea (HI15C2774, HI15C2859 and HI15C2888), from the National Research Foundation, funded by the Ministry of Science, ICT and Future Planning, Republic of Korea (NRF-2015R1A4A1042416), and from the Asan Institute for Life Sciences (Grant No. 2016-462). It was also supported by the Korean Society for Chemotherapy.

    • Competing interests None declared.

    • Ethics approval Asan Medical Center Institutional Review Board.

    • Provenance and peer review Not commissioned; externally peer reviewed.

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