title: SARS in Singapore--predictors of disease severity.
abstract: 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.
authors.affiliation: Department of Internal Medicine, Singapore General Hospital, Singapore. hoe_nam@yahoo.com.sg
authors.forename: Hoe-Nam
authors.initials: HN
authors.lastname: Leong
authors.forename: Arul
authors.initials: A
authors.lastname: Earnest
authors.forename: Hong-Huay
authors.initials: HH
authors.lastname: Lim
authors.forename: Chee-Fang
authors.initials: CF
authors.lastname: Chin
authors.forename: Colin  S H
authors.initials: C
authors.lastname: Tan
authors.forename: Mark E
authors.initials: ME
authors.lastname: Puhaindran
authors.forename: Alex  C H
authors.initials: A
authors.lastname: Tan
authors.forename: Mark I C
authors.initials: MI
authors.lastname: Chen
authors.forename: Yee-Sin
authors.initials: YS
authors.lastname: Leo
mesh_terms: 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
chemical_list: D000914:Antibodies, Viral; D004279:DNA, Viral