title: Presentation and outcome of Middle East respiratory syndrome in Saudi intensive care unit patients.
abstract: BACKGROUND
  Middle East respiratory syndrome coronavirus infection is associated with high mortality rates but limited clinical data have been reported. We describe the clinical features and outcomes of patients admitted to an intensive care unit (ICU) with Middle East respiratory syndrome coronavirus (MERS-CoV) infection.
  
  
  METHODS
  Retrospective analysis of data from all adult (>18 years old) patients admitted to our 20-bed mixed ICU with Middle East respiratory syndrome coronavirus infection between October 1, 2012 and May 31, 2014. Diagnosis was confirmed in all patients using real-time reverse transcription polymerase chain reaction on respiratory samples.
  
  
  RESULTS
  During the observation period, 31 patients were admitted with MERS-CoV infection (mean age 59 ± 20 years, 22 [71 %] males). Cough and tachypnea were reported in all patients; 22 (77.4 %) patients had bilateral pulmonary infiltrates. Invasive mechanical ventilation was applied in 27 (87.1 %) and vasopressor therapy in 25 (80.6 %) patients during the intensive care unit stay. Twenty-three (74.2 %) patients died in the ICU. Nonsurvivors were older, had greater APACHE II and SOFA scores on admission, and were more likely to have received invasive mechanical ventilation and vasopressor therapy. After adjustment for the severity of illness and the degree of organ dysfunction, the need for vasopressors was an independent risk factor for death in the ICU (odds ratio = 18.33, 95 % confidence interval: 1.11-302.1, P = 0.04).
  
  
  CONCLUSIONS
  MERS-CoV infection requiring admission to the ICU is associated with high morbidity and mortality. The need for vasopressor therapy is the main risk factor for death in these patients.
authors.affiliation: Department of Intensive Care Services, Prince Sultan Military Medical City, Riyadh, 11159, Saudi Arabia. gmekhlafi@yahoo.com.
authors.forename: Ghaleb A
authors.initials: GA
authors.lastname: Almekhlafi
authors.affiliation: Intensive Care Unit, Prince Sultan Cardiac Center, Riyadh, 11159, Saudi Arabia.
authors.forename: Mohammed M
authors.initials: MM
authors.lastname: Albarrak
authors.affiliation: Department of Intensive Care Services, Prince Sultan Military Medical City, Riyadh, 11159, Saudi Arabia.
authors.forename: Yasser
authors.initials: Y
authors.lastname: Mandourah
authors.affiliation: Department of Intensive Care Services, Prince Sultan Military Medical City, Riyadh, 11159, Saudi Arabia.
authors.forename: Sahar
authors.initials: S
authors.lastname: Hassan
authors.affiliation: Department of Intensive Care Services, Prince Sultan Military Medical City, Riyadh, 11159, Saudi Arabia.
authors.forename: Abid
authors.initials: A
authors.lastname: Alwan
authors.affiliation: Department of Intensive Care Services, Prince Sultan Military Medical City, Riyadh, 11159, Saudi Arabia.
authors.forename: Abdullah
authors.initials: A
authors.lastname: Abudayah
authors.affiliation: Department of Intensive Care Services, Prince Sultan Military Medical City, Riyadh, 11159, Saudi Arabia.
authors.forename: Sultan
authors.initials: S
authors.lastname: Altayyar
authors.affiliation: Department of Intensive Care Services, Prince Sultan Military Medical City, Riyadh, 11159, Saudi Arabia.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Mustafa
authors.affiliation: Department of Intensive Care Services, Prince Sultan Military Medical City, Riyadh, 11159, Saudi Arabia.
authors.forename: Tareef
authors.initials: T
authors.lastname: Aldaghestani
authors.affiliation: Department of Intensive Care Services, Prince Sultan Military Medical City, Riyadh, 11159, Saudi Arabia.
authors.forename: Adnan
authors.initials: A
authors.lastname: Alghamedi
authors.affiliation: Department of Intensive Care Services, Prince Sultan Military Medical City, Riyadh, 11159, Saudi Arabia.
authors.forename: Ali
authors.initials: A
authors.lastname: Talag
authors.affiliation: Department of Intensive Care Services, Prince Sultan Military Medical City, Riyadh, 11159, Saudi Arabia.
authors.forename: Muhammad K
authors.initials: MK
authors.lastname: Malik
authors.affiliation: Department of Medicine, King Faisal Specialist Hospital and Research Centre, Riyadh, 11211, Saudi Arabia.
authors.forename: Ali S
authors.initials: AS
authors.lastname: Omrani
authors.affiliation: Department of Anesthesiology and Intensive Care, Uniklinikum Jena, 07743, Jena, Germany.
authors.forename: Yasser
authors.initials: Y
authors.lastname: Sakr
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D018352:Coronavirus Infections / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D065207:Middle East Respiratory Syndrome Coronavirus / Q000472:pathogenicity*; D012121:Respiration, Artificial / Q000401:mortality; D012189:Retrospective Studies; D012529:Saudi Arabia
keywords: Coronavirus; Epidemic; MERS-CoV; Respiratory failure; Saudi Arabia