| Autor: |
Lau, Arthur Chun-Wing, So, Loletta Kit-Ying, Miu, Flora Pui-Ling, Yung, Raymond Wai-Hung, Poon, Edwin, Cheung, Thomas Man-Tat, Yam, Loretta Yin-Chun |
| Předmět: |
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| Zdroj: |
Respirology; Jun2004, Vol. 9 Issue 2, p173-183, 11p |
| Abstrakt: |
Outcome of coronavirus-associated severe acute respiratory syndrome using a standard treatment protocol LAU ACW, SO LKY, MIU FPL, YUNG RWH, POON E, CHEUNG TMT, YAM LYC. Respirology 2004; 9: 173–183 There is so far no consensus on the optimal treatment strategy for the coronavirus-associated severe acute respiratory syndrome (SARS). We aimed to analyse the outcomes of a standard treatment strategy comprising antibiotics, a combination of ribavirin, a 3-week step-down course of corticosteroids, and the possibility of pulsed methylprednisolone rescue in the event of deterioration. This was a prospective cohort study performed at a major public-funded hospital in Hong Kong. Eighty-eight World Health Organisation/Centers for Disease Control and Prevention probable cases of SARS (97% laboratory-confirmed) were treated with a standard protocol previously reported. Seventy-one patients treated de novo were analysed in detail with regard to time to clinical stabilization after combination treatment, requirement of additional therapy (pulsed methylprednisolone; assisted ventilation); and final outcomes (recovery, mortality). The mean age was 42. Twenty-one patients (24%) had comorbidities. Three of 71 treated de novo recovered with antibiotics alone. The remaining 68 received combination treatment at a mean of 5.8 days after symptom onset, of whom 30 subsequently required pulsed methylprednisolone rescue (independent predictors: older age and higher LDH) and 18 required assisted ventilation (independent predictors: older age, higher oxygen requirement and creatinine level). Their median time to clinical stabilization was 8.0 days after combination treatment (independent predictor for longer time to stabilization: median age of 41 or above). Common complications were hyperglycaemia (58%), pneumo-mediastinum/thoraces (13%), psychiatric manifestations (7%) and ventilator-associated pneumonia (2%). One patient (1%) died of SARS-related respiratory failure. All-cause mortality was 3.4%, occurring in patients aged > 65 years only. None of the discharged survivors required continuation of oxygen therapy. This standard treatment protocol resulted in overall satisfactory outcomes. Randomized controlled trial is suggested to confirm its efficacy. [ABSTRACT FROM AUTHOR] |
| Databáze: |
Complementary Index |
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