Severe acute respiratory syndrome: report of treatment and outcome after a major outbreak.
BACKGROUND
The outcome is reported of a prospective uncontrolled study based on a stepwise treatment protocol during an outbreak of severe acute respiratory syndrome (SARS) in Hong Kong.


METHODS
One hundred and thirty eight patients were treated with broad spectrum antibiotics, a combination of ribavirin and low dose corticosteroid, and then intravenous high dose methylprednisolone according to responses. Sustained response to treatment was defined as (1) defervescence for > or =4 consecutive days, (2) resolution of lung consolidation by >25%, and (3) oxygen independence by the fourth day without fever. Patients with defervescence who achieved either criterion 2 or 3 were classified as partial responders. Patients who fell short of criteria 2 and 3 were non-responders.


RESULTS
Laboratory confirmation of SARS coronavirus infection was established in 132 (95.7%). None responded to antibiotics but 25 (18.1%) responded to ribavirin + low dose corticosteroid. Methylprednisolone was used in 107 patients, of whom 95 (88.8%) responded favourably. Evidence of haemolytic anaemia was observed in 49 (36%). A high level of C-reactive protein at presentation was the only independent predictor for use of methylprednisolone (odds ratio 2.18 per 10 mg/dl increase, 95% confidence interval 1.12 to 4.25, p = 0.02). Thirty seven patients (26.8%) required admission to the intensive care unit and 21 (15.2%) required invasive mechanical ventilation. There were 15 deaths (mortality rate 10.9%), most with significant co-morbidities, whereas 122 (88.4%) had been discharged home 4 months after the outbreak onset.


CONCLUSIONS
The use of high dose pulse methylprednisolone during the clinical course of a SARS outbreak was associated with clinical improvement, but randomised controlled trials are needed to ascertain its efficacy in this condition.
Sung
J J Y
JJ
Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong.
Wu
A
A
Joynt
G M
GM
Yuen
K Y
KY
Lee
N
N
Chan
P K S
PK
Cockram
C S
CS
Ahuja
A T
AT
Yu
L M
LM
Wong
V W
VW
Hui
D S C
DS
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000890:Anti-Infective Agents / Q000627:therapeutic use; D003422:Critical Care; D004196:Disease Outbreaks; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage; D006723:Hong Kong / Q000453:epidemiology; D006801:Humans; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage; D008875:Middle Aged; D012121:Respiration, Artificial; D012128:Respiratory Distress Syndrome / Q000453:epidemiology / Q000401:mortality / Q000628:therapy*; D016896:Treatment Outcome
D000890:Anti-Infective Agents; D005938:Glucocorticoids; D008775:Methylprednisolone