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
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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.