Rainer T H, Lee N, Ip M, Galvani A P, Antonio G E, Wong K T, Chan D P N, Ng A W H, Shing K K, Chau S S L, Mak P, Chan P K S, Ahuja A T, Hui D S, Sung J J Y
Accident and Emergency Medicine Academic Unit, The Chinese University of Hong Kong, Rooms 107/113, 1st Floor, Shatin, NT, Hong Kong.
Eur J Clin Microbiol Infect Dis. 2007 Feb;26(2):121-9. doi: 10.1007/s10096-006-0246-4.
This study investigated the discriminatory features of severe acute respiratory syndrome (SARS) and severe non-SARS community-acquired viral respiratory infection (requiring hospitalization) in an emergency department in Hong Kong. In a case-control study, clinical, laboratory and radiological data from 322 patients with laboratory-confirmed SARS from the 2003 SARS outbreak were compared with the data of 253 non-SARS adult patients with confirmed viral respiratory tract infection from 2004 in order to identify discriminatory features. Among the non-SARS patients, 235 (93%) were diagnosed as having influenza infections (primarily H3N2 subtype) and 77 (30%) had radiological evidence of pneumonia. In the early phase of the illness and after adjusting for baseline characteristics, SARS patients were less likely to have lower respiratory symptoms (e.g. sputum production, shortness of breath, chest pain) and more likely to have myalgia (p < 0.001). SARS patients had lower mean leukocyte and neutrophil counts (p < 0.0001) and more commonly had "ground-glass" radiological changes with no pleural effusion. Despite having a younger average age, SARS patients had a more aggressive respiratory course requiring admission to the ICU and a higher mortality rate. The area under the receiver operator characteristic curve for predicting SARS when all variables were considered was 0.983. Using a cutoff score of >99, the sensitivity was 89.1% (95%CI 82.0-94.0) and the specificity was 98.0% (95%CI 95.4-99.3). The area under the receiver operator characteristic curve for predicting SARS when all variables except radiological change were considered was 0.933. Using a cutoff score of >8, the sensitivity was 80.7% (95%CI 72.4-87.3) and the specificity was 94.5% (95%CI 90.9-96.9). Certain clinical manifestations and laboratory changes may help to distinguish SARS from other influenza-like illnesses. Scoring systems may help identify patients who should receive more specific tests for influenza or SARS.
本研究调查了香港某急诊科中严重急性呼吸综合征（SARS）与严重非SARS社区获得性病毒性呼吸道感染（需住院治疗）的鉴别特征。在一项病例对照研究中，将2003年SARS疫情中322例实验室确诊SARS患者的临床、实验室和放射学数据与2004年253例确诊病毒性呼吸道感染的非SARS成年患者的数据进行比较，以确定鉴别特征。在非SARS患者中，235例（93%）被诊断为流感感染（主要为H3N2亚型），77例（30%）有肺炎的放射学证据。在疾病早期并调整基线特征后，SARS患者出现下呼吸道症状（如咳痰、气短、胸痛）的可能性较小，而出现肌痛的可能性较大（p<0.001）。SARS患者的平均白细胞和中性粒细胞计数较低（p<0.0001），更常见的是出现“磨玻璃”样放射学改变且无胸腔积液。尽管SARS患者的平均年龄较小，但他们的呼吸道病程更凶险，需要入住重症监护病房，死亡率更高。当考虑所有变量时，预测SARS的受试者工作特征曲线下面积为0.983。使用>99的截断分数，敏感性为89.1%（95%CI 82.0 - 94.0），特异性为98.0%（95%CI 95.4 - 99.3）。当考虑除放射学改变外的所有变量时，预测SARS的受试者工作特征曲线下面积为0.933。使用>8的截断分数，敏感性为80.7%（95%CI 72.4 - 87.3），特异性为94.5%（95%CI 90.9 - 96.9）。某些临床表现和实验室变化可能有助于将SARS与其他流感样疾病区分开来。评分系统可能有助于识别那些应接受更特异性流感或SARS检测的患者。
