Nam Hae-Sung, Park Jung Wan, Ki Moran, Yeon Mi-Yeon, Kim Jin, Kim Seung Woo
Department of Preventive Medicine and Public Health, Chungnam National University School of Medicine, Daejeon, Republic of Korea.
Division of Infectious Disease Surveillance, Korea Centers for Disease Control and Prevention, Cheongju, Republic of Korea.
Int J Infect Dis. 2017 May;58:37-42. doi: 10.1016/j.ijid.2017.02.008. Epub 2017 Feb 20.
To explore the epidemiological and clinical factors predictive of the case fatality rate (CFR) of Middle East respiratory syndrome-coronavirus (MERS-CoV) infection in an outbreak in Daejeon, the Republic of Korea.
We reviewed the outbreak investigation reports and medical records of 1 index case and 25 additional MERS cases in hospitals A (14 cases) and B (11 cases), and conducted an in-depth interview with the index case.
The CFR in hospital B was higher than that in hospital A (63.6% vs. 28.6%, respectively). Higher MERS-CoV exposure conditions were also found in hospital B, including aggravated pneumonia in the index case and nebulizer use in a six-bed admission room. The host factors associated with high CFR were pre-existing pneumonia, smoking history, an incubation period of less than 5 days, leukocytosis, abnormal renal function at diagnosis, and respiratory symptoms such as sputum and dyspnea.
The conditions surrounding MERS-CoV exposure and the underlying poor pulmonary function due to a smoking history or pre-existing pneumonia may explain the high CFR in hospital B. The clinical features described above may enable prediction of the prognosis of MERS cases.
探讨韩国大田市一起中东呼吸综合征冠状病毒（MERS-CoV）感染暴发中病死率（CFR）的流行病学和临床预测因素。
我们回顾了A医院（14例）和B医院（11例）1例首例病例及另外25例MERS病例的暴发调查报告和病历，并对首例病例进行了深入访谈。
B医院的病死率高于A医院（分别为63.6%和28.6%）。在B医院还发现了更高的MERS-CoV暴露条件，包括首例病例的重症肺炎以及在一个六人间病房使用雾化器。与高病死率相关的宿主因素包括既往肺炎、吸烟史、潜伏期少于5天、白细胞增多、诊断时肾功能异常以及咳痰和呼吸困难等呼吸道症状。
MERS-CoV暴露的相关条件以及因吸烟史或既往肺炎导致的潜在肺功能不佳可能解释了B医院的高病死率。上述临床特征可能有助于预测MERS病例的预后。
