Clinical Features of 139 Patients Died with SARS in Beijing Area

摘要

Objective To describe the clinical characteristics and how these patients were treated and possible risk factors correlated with death. Methods Retrospective cases involving 139 patients died with a diagnosis of clinically diagnosed SARS defined by Chinese Ministry of Health reported from 29 hospitals in Beijing area between March 25 and May 22, 2003 were enrolled in our study. Results There were 74 male patients and 65 female patients, The mean age of these patients was 56. 8 +- 15. 9 years (from 17 to 90) .In which, 67 cases (48.2%) were 60 years or older. The most common complaint were fever (in 100 percent of the patients) ; chills,rigor,or both (39.4 %); myalgia (37.7%); cough (76.9%); and headache (51.2%) . Other symptoms included sputum production (in 31.8%); sore throat (25.0%); nausea and vomiting (15.8%); diarrhea (21.7%); and dizziness (4.3%).A total of 80 patients (57.6%) had coexisting conditions: cardiovascular and cerebrovascular disease in 47 (33.8%), diabetes mellitus in 31 (22. 3%), chronic pulmonary disease in 7 (5.0%), tumor in 7 (5.0%),chronic liver disease in 6 (4.3%) and chronic renal failure in 3 (2.1%) .The initial blood counts showed white cell count were normal in most cases, and 97 cases (69.8%) had lymphopenia. The subsets of CD3~+ , CD4~+ and CD8~+ T lymphocytes had a sharp decrease in absolute count in all cases been tested on admission. Many patients demonstrated red blood cell and hemoglobin lowering and total bilirubin increasing after admission. Serum chemical values including alanine aminotransferase, creatine kinase, lactate dehydrogenase were abnormal in many cases during hospitalization. Fasting plasma glucose were elevated higher then 7.0 mmol/L in 82.7 percent of patients. Conclusion Old age is the major influencing factor to prognosis in SARS patients. Coexisting conditions such as diabetes and cardiovascular and cerebrovascular diseases are also the contributing factors to the death of patients. The damage of cellular immunity is probably an important mechanism of pathogenesis of SARS. Although general combination therapy may be effective in most patients, side effects should also be considered.