Adverse effects of ribavirin and outcome in severe acute respiratory syndrome: experience in two medical centers.
OBJECTIVE
To assess the effect of ribavirin-induced anemia on the outcome of severe acute respiratory syndrome (SARS).


METHODS
A retrospective observational study.


METHODS
Two medical centers in Taiwan.


METHODS
Forty-four patients with SARS who received ribavirin and 7 patients with SARS who did not receive ribavirin.


RESULTS
The mean peak C-reactive protein and lactate dehydrogenase levels were higher in SARS patients who were receiving ribavirin therapy than in SARS patients who were not receiving ribavirin therapy. The mortality was also higher, but the difference was not statistically significant. On multivariate analysis, hemoglobin level was an independent prognostic correlate of hypoxemia or mortality (odds ratio, 2.0; 95% confidence interval, 1.1 to 3.8; p = 0.03). The hemoglobin began decreasing in two thirds of SARS patients (32 of 44 patients; 73%) who were receiving ribavirin 3 days after therapy with the antiviral drug was started. Patients with a drop in hemoglobin level of > 2 g/dL had a significantly higher mortality rate than the other patients. Hypoxemia developed in one third of SARS patients (17 of 44 patients; 39%) who were receiving ribavirin, all of whom were anemic. Of the 17 hypoxemic patients, 11 (65%) had a drop in hemoglobin of > 2 g/dL, and 4 patients (24%) required a blood transfusion. The mean slope of the hemoglobin decrease was significantly steeper (p = 0.001) in hypoxemic patients with SARS who were receiving ribavirin than in the nonhypoxemic patients with SARS who were receiving ribavirin. Only one of seven SARS patients (14%) who was not receiving ribavirin became anemic, but this individual was not hypoxemic. Eventually, 5 of 17 hypoxemic and anemic SARS patients (29%) who were receiving ribavirin died. The combination of hypoxia with anemia was thus significantly associated with a higher mortality (p < 0.001).


CONCLUSIONS
Hypoxia combined with anemia increased the risk for death in SARS patients. Unless ribavirin can be shown to be effective against SARS-coronavirus, the risk of anemia posed by this drug argues against its use in SARS patients.
Division of Chest Medicine, Department of Internal Medicine, Mackay Memorial Hospital, #92 Sec. 2 Chung-Shan North Road, Taipei 10449, Taiwan.
Hsueh-Erh
HE
Chiou
Ching-Lung
CL
Liu
Mary Jeanne
MJ
Buttrey
Han-Pin
HP
Kuo
Hui-Wen
HW
Liu
Hsu-Tah
HT
Kuo
Yen-Ta
YT
Lu
D000328:Adult; D000740:Anemia / Q000139:chemically induced; D000998:Antiviral Agents / Q000009:adverse effects* / Q000627:therapeutic use; D016009:Chi-Square Distribution; D021821:Communicable Diseases, Emerging / Q000188:drug therapy* / Q000453:epidemiology; D005260:Female; D006801:Humans; D000860:Hypoxia / Q000139:chemically induced; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012254:Ribavirin / Q000009:adverse effects* / Q000627:therapeutic use; D012307:Risk Factors; D045169:Severe Acute Respiratory Syndrome / Q000188:drug therapy* / Q000453:epidemiology; D018709:Statistics, Nonparametric; D013624:Taiwan / Q000453:epidemiology; D016896:Treatment Outcome
D000998:Antiviral Agents; D012254:Ribavirin