Outcome of coronavirus-associated severe acute respiratory syndrome using a standard treatment protocol.
OBJECTIVE
There is so far no consensus on the optimal treatment strategy for the coronavirus-associated severe acute respiratory syndrome (SARS). We aimed to analyse the outcomes of a standard treatment strategy comprising antibiotics, a combination of ribavirin, a 3-week step-down course of corticosteroids, and the possibility of pulsed methylprednisolone rescue in the event of deterioration.


METHODS
This was a prospective cohort study performed at a major public-funded hospital in Hong Kong. Eighty-eight World Health Organisation/Centers for Disease Control and Prevention probable cases of SARS (97% laboratory-confirmed) were treated with a standard protocol previously reported. Seventy-one patients treated de novo were analysed in detail with regard to time to clinical stabilization after combination treatment, requirement of additional therapy (pulsed methylprednisolone; assisted ventilation); and final outcomes (recovery, mortality).


RESULTS
The mean age was 42. Twenty-one patients (24%) had comorbidities. Three of 71 treated de novo recovered with antibiotics alone. The remaining 68 received combination treatment at a mean of 5.8 days after symptom onset, of whom 30 subsequently required pulsed methylprednisolone rescue (independent predictors: older age and higher LDH) and 18 required assisted ventilation (independent predictors: older age, higher oxygen requirement and creatinine level). Their median time to clinical stabilization was 8.0 days after combination treatment (independent predictor for longer time to stabilization: median age of 41 or above). Common complications were hyperglycaemia (58%), pneumo-mediastinum/thoraces (13%), psychiatric manifestations (7%) and ventilator-associated pneumonia (2%). One patient (1%) died of SARS-related respiratory failure. All-cause mortality was 3.4%, occurring in patients aged > 65 years only. None of the discharged survivors required continuation of oxygen therapy.


CONCLUSIONS
This standard treatment protocol resulted in overall satisfactory outcomes. Randomized controlled trial is suggested to confirm its efficacy.
Lau
Arthur Chun-Wing
AC
Division of Respiratory and Critical Care Medicine, Department of Medicine, Pamela Youde Nethersole Eastern Hospital, Hong Kong SAR, PR China. drcwlau@hkstar.com
So
Loletta Kit-Ying
LK
Miu
Flora Pui-Ling
FP
Yung
Raymond Wai-Hung
RW
Poon
Edwin
E
Cheung
Thomas Man-Tat
TM
Yam
Loretta Yin-Chun
LY
D000293:Adolescent; D000328:Adult; D000368:Aged; D000998:Antiviral Agents / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D015897:Comorbidity; D005260:Female; D006801:Humans; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage*; D008875:Middle Aged; D011446:Prospective Studies; D020551:Pulse Therapy, Drug; D011859:Radiography; D012121:Respiration, Artificial; D012254:Ribavirin / Q000627:therapeutic use*; D045169:Severe Acute Respiratory Syndrome / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000453:epidemiology / Q000628:therapy; D016896:Treatment Outcome
D000998:Antiviral Agents; D012254:Ribavirin; D008775:Methylprednisolone