A cluster of patients with severe acute respiratory syndrome in a chest ward in southern Taiwan

Wang, Yi-Hsi; Lin, An-Shen; Chao, Tung-Ying; Lu, Sheng-Nan; Liu, Jien-Wei; Chen, Shun-Sheng; Lin, Meng-Chih

OBJECTIVE: Severe acute respiratory syndrome (SARS) is an emerging and easily clustering infectious disease. We describe an outbreak of SARS in a chest ward of a medical center in southern Taiwan and seek to identify the risk factors of those SARS patients who required mechanical ventilation. We focus on previous health patients. DESIGN: This retrospective case series was collected during the SARS outbreak. Degrees of severity were established, based on whether intubation and mechanical ventilation was necessary. SETTING: A 2500-bed medical center in southern Taiwan. PATIENTS: Forty-four patients exhibited symptoms that met the modified World Health Organization (WHO) definition of SARS. These included of three subgroups: health-care workers (n=16), relatives (n=14), and patients already admitted for other ailments (n=14). Of these, 20 eventually required mechanical ventilation. MEASUREMENTS AND RESULTS: Laboratory analyses showed statistically significant differences between intubated and nonintubated patients in white blood cell count, neutrophil percentage, and C-reactive protein level as well as in age and underlying malignancy. Risk factors for SARS patients who had been healthy prior to their illness included old age, high peak fever grade, increased neutrophil count, increased neutrophil percentage, and close or prolonged contact with a SARS patient. CONCLUSIONS: Old age, high white blood cell counts, high peak grade fever, and close or prolonged contact with a SARS patient increase the risk of intubation in previous healthy SARS patients.