Clinical characteristics of fatal patients with severe acute respiratory syndrome in a medical center in Taipei.
BACKGROUND
The clinical spectrum of severe acute respiratory syndrome (SARS) varies widely in the way that asymptomatic carriers are believed to exist in the community. Still there are severe forms of illness in which the patients deteriorate unexpectedly within hours. This study delineates clinical characteristics of such fatal cases of SARS for the purpose of identifying patients with poor outcome.


METHODS
Patients with the diagnosis of probable or suspected SARS admitted to the Taipei Veterans General Hospital during the period from March 26, 2003 to May 25, 2003 were included. The medical records of fatal cases were retrospectively reviewed.


RESULTS
During the study period, thirty-six probable cases and 17 suspected cases of SARS were identified. Eight probable but none of the suspected cases died from acute respiratory distress syndrome (ARDS) with multiple organ dysfunction after a median of 6-day hospital stay (range, 1-30 days). All but 2 patients acquired the infection nosocomially. Of the fatal cases, four were males and 4 females, with the median age of 65 years (range, 29-76 yrs). All except 3 had co-morbid conditions, such as hypertension, diabetes mellitus, coronary artery disease or chronic obstructive pulmonary disease. The lactate dehydrogenase (LDH) values were abnormal (> 200 U/L) in all patients. The chest radiograph of these fatal cases consistently showed multifocal infiltration over the unilateral or bilateral lobe of the lung.


CONCLUSIONS
Patients of SARS who had advanced age, co-morbid conditions, highly elevated LDH and multifocal infiltration over chest radiograph should be closely monitored and actively treated.
Wong
Wing-Wai
WW
Division of Infectious Diseases, Department of Medicine, Taipei Veteran General Hospital, Taipei, Taiwan, ROC. wwwong@vghtpe.gov.tw
Chen
Te-Li
TL
Yang
Su-Pen
SP
Wang
Fu-Der
FD
Cheng
Nai-Cheng
NC
Kuo
Benjamin Ing-Tiau
BI
Yu
Kwok-Woon
KW
Tsai
Che-An
CA
Lin
Yu-Shia
YS
Lee
I-Ru
IR
Chi
Chih-Yu
CY
Lai
Chorng-Jang
CJ
Lai
Chung-Hsu
CH
Chen
Hsin-Pai
HP
Liu
Cheng-Yi
CY
D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D007770:L-Lactate Dehydrogenase / Q000097:blood; D008297:Male; D008875:Middle Aged; D045169:Severe Acute Respiratory Syndrome / Q000175:diagnosis / Q000401:mortality* / Q000635:transmission; D013624:Taiwan
D007770:L-Lactate Dehydrogenase