Outcomes and prognostic factors in 267 patients with severe acute respiratory syndrome in Hong Kong.
BACKGROUND
Severe acute respiratory syndrome (SARS) has become a global public health emergency.


OBJECTIVE
To evaluate the characteristics and outcomes of patients with SARS in Hong Kong and to identify predictors of mortality.


METHODS
Retrospective cohort study.


METHODS
Quarantine hospital for patients with SARS in Hong Kong.


METHODS
267 consecutive patients hospitalized from 26 February to 31 March 2003 for probable or confirmed SARS.


METHODS
Clinical, laboratory, and radiographic measures; 3-month mortality rate.


RESULTS
According to our case definition, there were 227 cases of confirmed SARS and 40 cases of probable SARS. Common presenting symptoms were fever (99% of patients), chills (74%), malaise (63%), and myalgia (50%). Laboratory findings included lymphopenia (73%), thrombocytopenia (50%), hyponatremia (60%), and elevated levels of lactate dehydrogenase (47%) and C-reactive protein (75%). During hospitalization, incidence of diarrhea (53%), anemia (53%), and acute renal failure (6%) increased. Sixty-nine patients (26%) required intensive care because of respiratory failure. The 3-month mortality rate was 12% (95% CI, 8% to 16%). Factors contributing to mortality were respiratory failure, acute renal failure, and nosocomial sepsis. On multivariate Cox regression, age older than 60 years (relative risk, 5.10 [CI, 2.30 to 11.31]; P < 0.001) and lactate dehydrogenase level greater than 3.8 micro kat/L at presentation (relative risk, 2.20 [CI, 1.03 to 4.71]; P = 0.04) were independent predictors of mortality.


CONCLUSIONS
Because of the longer follow-up period in our cohort, the mortality rate in these patients is higher than rates reported in previous studies. Advanced age and high lactate dehydrogenase level at presentation predict mortality. *For members of the Princess Margaret Hospital SARS Study Group, see the Appendix.
Choi
Kin Wing
KW
Princess Margaret Hospital, Kowloon, Hong Kong, China.
Chau
Tai Nin
TN
Tsang
Owen
O
Tso
Eugene
E
Chiu
Ming Chee
MC
Tong
Wing Lok
WL
Lee
Po Oi
PO
Ng
Tak Keung
TK
Ng
Wai Fu
WF
Lee
Kam Cheong
KC
Lam
William
W
Yu
Wai Cho
WC
Lai
Jak Yiu
JY
Lai
Sik To
ST
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D017934:Coronavirus / Q000302:isolation & purification; D005260:Female; D005500:Follow-Up Studies; D006723:Hong Kong / Q000453:epidemiology; D006801:Humans; D007770:L-Lactate Dehydrogenase / Q000097:blood; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D045169:Severe Acute Respiratory Syndrome / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy / Q000401:mortality*
D007770:L-Lactate Dehydrogenase