A Major Outbreak of Severe Acute Respiratory Syndrome in Hong Kong

N Engl J Med. 2003 May 15;348(20):1986-94. doi: 10.1056/NEJMoa030685. Epub 2003 Apr 7.

Abstract

Background: There has been an outbreak of the severe acute respiratory syndrome (SARS) worldwide. We report the clinical, laboratory, and radiologic features of 138 cases of suspected SARS during a hospital outbreak in Hong Kong.

Methods: From March 11 to 25, 2003, all patients with suspected SARS after exposure to an index patient or ward were admitted to the isolation wards of the Prince of Wales Hospital. Their demographic, clinical, laboratory, and radiologic characteristics were analyzed. Clinical end points included the need for intensive care and death. Univariate and multivariate analyses were performed.

Results: There were 66 male patients and 72 female patients in this cohort, 69 of whom were health care workers. The most common symptoms included fever (in 100 percent of the patients); chills, rigors, or both (73.2 percent); and myalgia (60.9 percent). Cough and headache were also reported in more than 50 percent of the patients. Other common findings were lymphopenia (in 69.6 percent), thrombocytopenia (44.8 percent), and elevated lactate dehydrogenase and creatine kinase levels (71.0 percent and 32.1 percent, respectively). Peripheral air-space consolidation was commonly observed on thoracic computed tomographic scanning. A total of 32 patients (23.2 percent) were admitted to the intensive care unit; 5 patients died, all of whom had coexisting conditions. In a multivariate analysis, the independent predictors of an adverse outcome were advanced age (odds ratio per decade of life, 1.80; 95 percent confidence interval, 1.16 to 2.81; P=0.009), a high peak lactate dehydrogenase level (odds ratio per 100 U per liter, 2.09; 95 percent confidence interval, 1.28 to 3.42; P=0.003), and an absolute neutrophil count that exceeded the upper limit of the normal range on presentation (odds ratio, 1.60; 95 percent confidence interval, 1.03 to 2.50; P=0.04).

Conclusions: SARS is a serious respiratory illness that led to significant morbidity and mortality in our cohort.

MeSH terms

  • Adult
  • Antiviral Agents / therapeutic use
  • Autopsy
  • Chills / etiology
  • Contact Tracing
  • Disease Outbreaks*
  • Drug Therapy, Combination
  • Female
  • Fever / etiology
  • Glucocorticoids / therapeutic use
  • Hong Kong / epidemiology
  • Humans
  • L-Lactate Dehydrogenase / blood
  • Lung / diagnostic imaging
  • Lung / pathology
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Prednisolone / therapeutic use
  • Prognosis
  • Radiography
  • Ribavirin / therapeutic use
  • Risk Factors
  • Severe Acute Respiratory Syndrome / complications
  • Severe Acute Respiratory Syndrome / diagnosis
  • Severe Acute Respiratory Syndrome / epidemiology*
  • Severe Acute Respiratory Syndrome / therapy

Substances

  • Antiviral Agents
  • Glucocorticoids
  • Ribavirin
  • Prednisolone
  • L-Lactate Dehydrogenase