SARS in Singapore--predictors of disease severity


Leong, HN; Earnest, A; Lim, HH; Chin, CF; Tan, CS; Puhaindran, ME; Tan, AC; Chen, MI; Leo, YS; (2006) SARS in Singapore--predictors of disease severity. Annals of the Academy of Medicine, Singapore, 35 (5). pp. 326-31. ISSN 0304-4602

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Abstract

INTRODUCTION: 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. MATERIALS AND 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. CONCLUSION: Advanced age, neutrophilia and high LDH predict poor outcomes in patients with SARS.

Item Type: Article
Keywords: Adolescent, Adult, Aged, Aged, 80 and over, Antibodies, Viral/*analysis, Child, Child, Preschool, DNA, Viral/*analysis, Female, Fluorescent Antibody Technique, Humans, Incidence, Infant, Male, Middle Aged, Retrospective Studies, Reverse Transcriptase Polymerase Chain Reaction, SARS Virus/*genetics/*immunology, Severe Acute Respiratory Syndrome/*epidemiology/virology, Severity of Illness Index, Singapore/epidemiology, Survival Rate, Adolescent, Adult, Aged, Aged, 80 and over, Antibodies, Viral, analysis, Child, Child, Preschool, DNA, Viral, analysis, Female, Fluorescent Antibody Technique, Humans, Incidence, Infant, Male, Middle Aged, Retrospective Studies, Reverse Transcriptase Polymerase Chain Reaction, SARS Virus, genetics, immunology, Severe Acute Respiratory Syndrome, epidemiology, virology, Severity of Illness Index, Singapore, epidemiology, Survival Rate
Faculty and Department: Faculty of Epidemiology and Population Health > Dept of Infectious Disease Epidemiology
PubMed ID: 16829999
Web of Science ID: 238381300004
URI: http://researchonline.lshtm.ac.uk/id/eprint/8677

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