SARS in Singapore--predictors of disease severity.
BACKGROUND
Severe acute respiratory syndrome (SARS) affected 8096 individuals in 29 countries, with 774 deaths. In Singapore, there were 238 cases of SARS with 33 deaths. A retrospective analysis was performed to identify predictors of poor outcome in patients with SARS locally.


METHODS
Clinical, laboratory and outcome data of 234 patients admitted to Tan Tock Seng Hospital and Singapore General Hospital were collected and analysed. Only data collected at the time of admission were used in the analysis for predictors of poor outcome. Adverse events were defined as admission to the intensive care unit or death.


RESULTS
Clinical (temperature, FiO2) and laboratory [leukocyte, lymphocyte, neutrophil, platelet, lactate dehydrogenase (LDH), albumin] trends in groups with and without an adversarial event were presented. Fifty patients experienced an adverse event. On univariate analysis, male gender, advanced age, presence of comorbidities, neutrophilia, lymphopaenia, hyponatraemia, hypoalbuminaemia, transaminitis and elevated LDH or C-reactive protein were found to be significant predictors. On multivariate analysis, predictors of poor outcome were increased age [odds ratio (OR) 1.73 for every 10-year increase; 95% CI, 1.35 to 2.21], neutrophilia (OR 1.06 for every 1 x 10(9)/L increase; 95% CI, 1.02 to 1.11) and high LDH (OR 1.17 for every 100 U/L increase; 95% CI, 1.02 to 1.34). None of the 12 paediatric patients had an adverse event.


CONCLUSIONS
Advanced age, neutrophilia and high LDH predict poor outcomes in patients with SARS.
Leong
Hoe-Nam
HN
Department of Internal Medicine, Singapore General Hospital, Singapore. hoe_nam@yahoo.com.sg
Earnest
Arul
A
Lim
Hong-Huay
HH
Chin
Chee-Fang
CF
Tan
Colin  S H
C
Puhaindran
Mark E
ME
Tan
Alex  C H
A
Chen
Mark I C
MI
Leo
Yee-Sin
YS
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000914:Antibodies, Viral / Q000032:analysis*; D002648:Child; D002675:Child, Preschool; D004279:DNA, Viral / Q000032:analysis*; D005260:Female; D005455:Fluorescent Antibody Technique; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D020133:Reverse Transcriptase Polymerase Chain Reaction; D045473:Severe acute respiratory syndrome-related coronavirus / Q000235:genetics* / Q000276:immunology*; D045169:Severe Acute Respiratory Syndrome / Q000453:epidemiology* / Q000821:virology; D012720:Severity of Illness Index; D012846:Singapore / Q000453:epidemiology; D015996:Survival Rate
D000914:Antibodies, Viral; D004279:DNA, Viral