Document Detail

Clinical features and short-term outcomes of 144 patients with SARS in the greater Toronto area.
MedLine Citation:
PMID:  12734147     Owner:  NLM     Status:  MEDLINE    
CONTEXT: Severe acute respiratory syndrome (SARS) is an emerging infectious disease that first manifested in humans in China in November 2002 and has subsequently spread worldwide.
OBJECTIVES: To describe the clinical characteristics and short-term outcomes of SARS in the first large group of patients in North America; to describe how these patients were treated and the variables associated with poor outcome.
DESIGN, SETTING, AND PATIENTS: Retrospective case series involving 144 adult patients admitted to 10 academic and community hospitals in the greater Toronto, Ontario, area between March 7 and April 10, 2003, with a diagnosis of suspected or probable SARS. Patients were included if they had fever, a known exposure to SARS, and respiratory symptoms or infiltrates observed on chest radiograph. Patients were excluded if an alternative diagnosis was determined.
MAIN OUTCOME MEASURES: Location of exposure to SARS; features of the history, physical examination, and laboratory tests at admission to the hospital; and 21-day outcomes such as death or intensive care unit (ICU) admission with or without mechanical ventilation.
RESULTS: Of the 144 patients, 111 (77%) were exposed to SARS in the hospital setting. Features of the clinical examination most commonly found in these patients at admission were self-reported fever (99%), documented elevated temperature (85%), nonproductive cough (69%), myalgia (49%), and dyspnea (42%). Common laboratory features included elevated lactate dehydrogenase (87%), hypocalcemia (60%), and lymphopenia (54%). Only 2% of patients had rhinorrhea. A total of 126 patients (88%) were treated with ribavirin, although its use was associated with significant toxicity, including hemolysis (in 76%) and decrease in hemoglobin of 2 g/dL (in 49%). Twenty-nine patients (20%) were admitted to the ICU with or without mechanical ventilation, and 8 patients died (21-day mortality, 6.5%; 95% confidence interval [CI], 1.9%-11.8%). Multivariable analysis showed that the presence of diabetes (relative risk [RR], 3.1; 95% CI, 1.4-7.2; P =.01) or other comorbid conditions (RR, 2.5; 95% CI, 1.1-5.8; P =.03) were independently associated with poor outcome (death, ICU admission, or mechanical ventilation).
CONCLUSIONS: The majority of cases in the SARS outbreak in the greater Toronto area were related to hospital exposure. In the event that contact history becomes unreliable, several features of the clinical presentation will be useful in raising the suspicion of SARS. Although SARS is associated with significant morbidity and mortality, especially in patients with diabetes or other comorbid conditions, the vast majority (93.5%) of patients in our cohort survived.
Christopher M Booth; Larissa M Matukas; George A Tomlinson; Anita R Rachlis; David B Rose; Hy A Dwosh; Sharon L Walmsley; Tony Mazzulli; Monica Avendano; Peter Derkach; Issa E Ephtimios; Ian Kitai; Barbara D Mederski; Steven B Shadowitz; Wayne L Gold; Laura A Hawryluck; Elizabeth Rea; Jordan S Chenkin; David W Cescon; Susan M Poutanen; Allan S Detsky
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Publication Detail:
Type:  Journal Article     Date:  2003-05-06
Journal Detail:
Title:  JAMA     Volume:  289     ISSN:  0098-7484     ISO Abbreviation:  JAMA     Publication Date:  2003 Jun 
Date Detail:
Created Date:  2003-06-04     Completed Date:  2003-06-12     Revised Date:  2014-09-17    
Medline Journal Info:
Nlm Unique ID:  7501160     Medline TA:  JAMA     Country:  United States    
Other Details:
Languages:  eng     Pagination:  2801-9     Citation Subset:  AIM; IM    
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MeSH Terms
Anti-Inflammatory Agents / therapeutic use
Antiviral Agents / adverse effects,  therapeutic use
Biological Markers / blood
Communicable Diseases, Emerging / blood,  diagnosis,  epidemiology,  therapy
Cough / etiology
Disease Outbreaks
Disease Progression
Dyspnea / etiology
Fever / etiology
Hydrocortisone / therapeutic use
Infection Control
Intensive Care Units
Lung / radiography
Middle Aged
Ontario / epidemiology
Proportional Hazards Models
Respiration, Artificial
Retrospective Studies
Ribavirin / adverse effects,  therapeutic use
SARS Virus / isolation & purification
Severe Acute Respiratory Syndrome* / blood,  diagnosis,  epidemiology,  therapy
Statistics, Nonparametric
Survival Analysis
Reg. No./Substance:
0/Anti-Inflammatory Agents; 0/Antiviral Agents; 0/Biological Markers; 49717AWG6K/Ribavirin; WI4X0X7BPJ/Hydrocortisone
Comment In:
ACP J Club. 2004 Jan-Feb;140(1):19   [PMID:  14711290 ]
JAMA. 2003 Jun 4;289(21):2861-3   [PMID:  12734146 ]
Erratum In:
JAMA. 2003 Jul 16;290(3):334

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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