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Published on: February 23, 2014
Predictive factors for pneumonia development and progression to respiratory failure in MERS-CoV infected patients
Jae-Hoon Ko1, Ga Eun Park1, Ji Yeon Lee1
1Division of Infectious Diseases, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 135-710, Republic of Korea.
Background:
After the 2015 Middle East respiratory syndrome (MERS) outbreak in Korea, prediction of pneumonia development and progression to respiratory failure was emphasized in control of MERS outbreak.
Methods:
MERS-CoV infected patients who were managed in a tertiary care center during the 2015 Korean MERS outbreak were reviewed. To analyze predictive factors for pneumonia development and progression to respiratory failure, we evaluated clinical variables measured within three days from symptom onset.
Results:
A total of 45 patients were included in the study: 13 patients (28.9%) did not develop pneumonia, 19 developed pneumonia without respiratory failure (42.2%), and 13 progressed to respiratory failures (28.9%). The identified predictive factors for pneumonia development included age ≥45 years, fever ≥37.5 °C, thrombocytopenia, lymphopenia, CRP ≥ 2 mg/dL, and a threshold cycle value of PCR less than 28.5. For respiratory failure, the indicators included male, hypertension, low albumin concentration, thrombocytopenia, lymphopenia, and CRP ≥ 4 mg/dL (all P < 0.05). With ≥ two predictive factors for pneumonia development, 100% of patients developed pneumonia. Patients lacking the predictive factors did not progress to respiratory failure.
Conclusion:
For successful control of MERS outbreak, MERS-CoV infected patients with ≥ two predictive factors should be intensively managed from the initial presentation.
Insights
Early identification of Middle East respiratory syndrome coronavirus (MERS-CoV) patients at high risk for pneumonia is crucial. Identifying key predictive factors aids in intensive management to prevent severe outcomes during MERS outbreaks.
Area of Science:
- Infectious Diseases
- Epidemiology
- Critical Care Medicine
Background:
- The 2015 Middle East respiratory syndrome (MERS) outbreak in Korea highlighted the need for predicting pneumonia and respiratory failure.
- Effective MERS-CoV outbreak control relies on early identification of at-risk patients.
Purpose of the Study:
- To identify clinical factors predicting pneumonia development and progression to respiratory failure in MERS-CoV infected patients.
- To inform early management strategies for MERS patients.
Main Methods:
- Retrospective review of 45 MERS-CoV infected patients from a 2015 Korean outbreak.
- Analysis of clinical variables within three days of symptom onset to identify predictive factors for pneumonia and respiratory failure.
Main Results:
- Predictive factors for pneumonia included age ≥45, fever, thrombocytopenia, lymphopenia, elevated CRP, and low PCR threshold cycle value.
- Predictors for respiratory failure included male sex, hypertension, low albumin, thrombocytopenia, lymphopenia, and elevated CRP.
- Patients with ≥2 pneumonia predictive factors invariably developed pneumonia; those without predictive factors did not progress to respiratory failure.
Conclusions:
- Intensive management of MERS-CoV infected patients with ≥2 identified predictive factors is recommended from initial presentation.
- Early risk stratification can guide clinical interventions and improve MERS outbreak control.
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