The use of corticosteroid as treatment in SARS was associated with adverse outcomes: a retrospective cohort study.
OBJECTIVE
To study the effect of corticosteroids in the treatment of severe acute respiratory syndrome (SARS).


METHODS
A retrospective cohort of 78 consecutive adult SARS patients admitted to a regional hospital in Hong Kong between March and May 2003 was analysed to study the effectiveness of corticosteroid. They were categorized according to whether or not corticosteroid therapy was given, and compared in terms of demographic characteristics, comorbidities, peak lactate dehydrogenase (LDH) levels and clinical outcomes. Established adverse prognostic factors including old age, comorbidities and high LDH levels were used as covariates in multiple logistic regressions to adjust for their confounding effect on adverse outcomes.


RESULTS
Among 78 patients, 66 patients (84.6%) received corticosteroid. The LDH level was similar in both groups. The corticosteroid group had more adverse outcomes (37.9% vs. 16.7%) despite younger age and less comorbidity. In multivariate analysis, corticosteroid treatment was associated with a 20.7-fold increase in risk of either ICU admission or mortality, independent of age and disease severity.


CONCLUSIONS
Despite more favourable baseline characteristics and similar peak LDH levels, SARS patients given corticosteroid had more adverse outcomes.
Auyeung
Tung Wai
TW
Department of Medicine and Geriatrics, Tuen Mun Hospital, Tuen Mun, New Territories, Hong Kong, China.
Lee
Jenny S W
JS
Lai
Wing Kin
WK
Choi
Chun Hung
CH
Lee
Hoi Kan
HK
Lee
Joo Shim
JS
Li
Po Chun
PC
Lok
Ka Ho
KH
Ng
Yuk Yung
YY
Wong
Wai Ming
WM
Yeung
Yiu Ming
YM
D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage* / Q000009:adverse effects*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003710:Demography; D004338:Drug Combinations; D005260:Female; D006723:Hong Kong / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011379:Prognosis; D012189:Retrospective Studies; D045169:Severe Acute Respiratory Syndrome / Q000188:drug therapy* / Q000453:epidemiology / Q000401:mortality; D016896:Treatment Outcome
D000305:Adrenal Cortex Hormones; D004338:Drug Combinations