Skip to main content
PMC home page
Elsevier - PMC COVID-19 Collection logoLink to Elsevier - PMC COVID-19 Collection
. 2009 Jul 13;68(1):4–10. doi: 10.1016/S1726-4901(09)70124-8

Clinical Features and Outcomes of Severe Acute Respiratory Syndrome and Predictive Factors for Acute Respiratory Distress Syndrome

Cheng-Yu Chen a,e, Chen-Hsen Lee e, Cheng-Yi Liu b,f, Jia-Horng Wang c,f, Lee-Min Wang d,f, Reury-Perng Perng a,f,*
PMCID: PMC7129615  PMID: 15742856

Abstract

Background

Severe acute respiratory syndrome (SARS) is an emerging infectious disease, and indeed, the SARS epidemic in Taiwan from March to July 2003 had a great impact. This study depicts the clinical characteristics and short-term outcomes of patients with SARS treated at Taipei Veterans General Hospital; potential predictive factors for acute respiratory distress syndrome (ARDS) are also analyzed.

Methods

This study retrospectively analyzed data for 67 SARS patients, who were grouped according to whether or not ARDS developed during the clinical course of SARS.

Results

There were 32 males (mean age, 50.3 years; range, 20–75 years) and 35 females (mean age, 51.1 years; range, 23–86 years). Twenty-five patients (37.3%) were health care workers. At admission, 50 patients (74.6%) had abnormal chest radiographs, and all patients developed pulmonary infiltrates during the following week. During hospitalization, lymphopenia was found in 57 patients (85.1%); and elevated levels of lactate dehydrogenase (LDH; n = 55; 83.3%), C-reactive protein (n = 55; 83.3%), aminotransferases (n = 44; 65.7%), and creatine kinase (n = 14; 20.9%) were also noted. ARDS developed in 33 patients (49.3%), who were generally older than the patients in whom ARDS did not develop, male, non-health care workers, and who generally had dyspnea at the time of diagnosis, and a history of diabetes mellitus, hypertension or cerebrovascular accident. Patients with, versus those without, ARDS also tended to present with more severe lymphopenia and leukocytosis, and with higher levels of LDH and aspartate aminotransferase. The overall mortality rate was 31.3% (21/67), whereas the rate for patients who developed ARDS was 63.6% (21/33). Multivariate analyses showed that age greater than 65 years (odds ratio, OR, 10.6; 95% confidence interval, CI, 2.1–54.1), pre-existing diabetes mellitus (OR, 13.7; 95% CI, 1.3–146.9), and elevated levels of LDH (OR, 8.4; 95% CI, 1.9–36.9) at admission, were independent predictors of ARDS.

Conclusion

The clinical manifestations of SARS showed high variability, and were related to the underlying health status of individual patients. Importantly, the development of ARDS was associated with significant mortality, despite aggressive therapy.

Key Words: acute respiratory distress syndrome, pneumonia, severe acute respiratory syndrome

References

  • 1.Drazen JM. Case clusters of the severe acute respiratory syndrome. N Engl J Med. 2003;348:e6–e7. doi: 10.1056/NEJMe030062. [DOI] [PubMed] [Google Scholar]
  • 2.Booth CM, Matukas LM, Tomlinson GA, Rachlis AR, Rose DB, Dwosh HA, Walmsley SL. Clinical features and short-term outcomes of 144 patients with SARS in the Greater Toronto Area. JAMA. 2003;289:2801–2809. doi: 10.1001/jama.289.21.JOC30885. [Erratum in: JAMA 2003;290:334.] [DOI] [PubMed] [Google Scholar]
  • 3.Tsang KW, Ho PL, Ooi GC, Yee WK, Wang T, Chan-Yeung M, Lam WK. A cluster of cases of severe acute respiratory syndrome in Hong Kong. N Engl J Med. 2003;348:1977–1985. doi: 10.1056/NEJMoa030666. [DOI] [PubMed] [Google Scholar]
  • 4.Lee N, Hui D, Wu A, Chan P, Cameron P, Joynt G, Ahuja A. A major outbreak of severe acute respiratory syndrome in Hong Kong. N Engl J Med. 2003;348:1986–1994. doi: 10.1056/NEJMoa030685. [DOI] [PubMed] [Google Scholar]
  • 5.World Health Organization. Severe acute respiratory syndrome (SARS). Available from: http://www.who.int/csr/sars [Date accessed: May 18, 2004.]
  • 6.Twu SJ, Chen TJ, Chen CJ, Olsen SJ, Lee LT, Fisk T, Hsu KH. Control measures for severe acute respiratory syndrome (SARS) in Taiwan. Emerg Infect Dis. 2003;9:718–720. doi: 10.3201/eid0906.030283. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 7.Centers for Disease Control and Prevention Update: severe acute respiratory syndrome - Taiwan, 2003. MMWR Morb Mortal Wkly Rep. 2003;52:461–466. [PubMed] [Google Scholar]
  • 8.Poutanen SM, Low DE, Henry B, Finkelstein S, Rose D, Green K, Tellier R. Identification of severe acute respiratory syndrome in Canada. N Engl J Med. 2003;348:1995–2005. doi: 10.1056/NEJMoa030634. [DOI] [PubMed] [Google Scholar]
  • 9.Drosten C, Gnther S, Preiser W, van der Werf S, Brodt HR, Becker S, Rabenau H. Identification of a novel coronavirus in patients with severe acute respiratory syndrome. N Engl J Med. 2003;348:1967–1976. doi: 10.1056/NEJMoa030747. [DOI] [PubMed] [Google Scholar]
  • 10.Ksiazek TG, Erdman D, Goldsmith CS, Zaki SR, Peret T, Emery S, Tong S. A novel coronavirus associated with severe acute respiratory syndrome. N Engl J Med. 2003;348:1953–1966. doi: 10.1056/NEJMoa030781. [DOI] [PubMed] [Google Scholar]
  • 11.Peiris JS, Lai ST, Poon LL, Guan Y, Yam LY, Lim W, Nicholls J. Coronavirus as a possible cause of severe acute respiratory syndrome. Lancet. 2003;361:1319–1325. doi: 10.1016/S0140-6736(03)13077-2. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 12.Chiang CH, Chen HM, Shih JF, Su WJ, Perng RP. Management of hospital-acquired severe acute respiratory syndrome with different disease spectrum. J Chin Med Assoc. 2003;66:328–338. [PubMed] [Google Scholar]
  • 13.Bernard GR, Artigas A, Brigham KL, Carlet J, Falke K, Hudson L, Lamy M. The American-European consensus conference on ARDS: definitions, mechanisms, relevant outcomes, and clinical trial coordination. Am J Respir Crit Care Med. 1994;149:818–824. doi: 10.1164/ajrccm.149.3.7509706. [DOI] [PubMed] [Google Scholar]
  • 14.Rainer TH, Cameron PA, Smit D, Ong KL, Hung AN, Nin DC, Ahuja AT. Evaluation of WHO criteria for identifying patients with severe acute respiratory syndrome out of hospital: prospective observational study. BMJ. 2003;326:1354–1358. doi: 10.1136/bmj.326.7403.1354. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 15.Poon LL, Wong OK, Chan KH, Luk W, Yuen KY, Peiris JS, Guan Y. Rapid diagnosis of a coronavirus associated with severe acute respiratory syndrome. Clin Chem. 2003;49:953–955. doi: 10.1373/49.6.953. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 16.Falsey AR, Walsh EE, Hayden FG. Rhinovirus and coronavirus infection-associated hospitalizations among older adults. J Infect Dis. 2002;185:1338–1341. doi: 10.1086/339881. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 17.El-Sahly HM, Atmar RL, Glezen WP, Greenberg SB. Spectrum of clinical illness in hospitalized patients with 'common cold' virus infections. Clin Infect Dis. 2000;31:96–100. doi: 10.1086/313937. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 18.Wong KT, Antonio GE, Hui D, Lee N, Yuen E, Wu A, Leung CB. Severe acute respiratory syndrome: radiographic appearances and pattern progression in 138 patients. Radiology. 2003;228:401–406. doi: 10.1148/radiol.2282030593. [DOI] [PubMed] [Google Scholar]
  • 19.Wong KT, Antonio GE, Hui D, Lee N, Yuen E, Wu A, Leung CB. Thin-section CT of severe acute respiratory syndrome: evaluation of 73 patients exposed to or with the disease. Radiology. 2003;228:395–400. doi: 10.1148/radiol.2283030541. [DOI] [PubMed] [Google Scholar]

Articles from Journal of the Chinese Medical Association are provided here courtesy of Elsevier

RESOURCES