Treatment outcomes for patients with Middle Eastern Respiratory Syndrome Coronavirus (MERS CoV) infection at a coronavirus referral center in the Kingdom of Saudi Arabia

Abstract

BackgroundMiddle Eastern Respiratory Syndrome coronavirus (MERS-CoV) is a poorly understood disease with no known treatments. We describe the clinical features and treatment outcomes of patients with laboratory confirmed MERS-CoV at a regional referral center in the Kingdom of Saudi Arabia.MethodsIn 2014, a retrospective chart review was performed on patients with a laboratory confirmed diagnosis of MERS-CoV to determine clinical and treatment characteristics associated with death. Confounding was evaluated and a multivariate logistic regression was performed to assess the independent effect of treatments administered.ResultsFifty-one patients had an overall mortality of 37 %. Most patients were male (78 %) with a mean age of 54 years. Almost a quarter of the patients were healthcare workers (23.5 %) and 41 % had a known exposure to another person with MERS-CoV. Survival was associated with male gender, working as a healthcare worker, history of hypertension, vomiting on admission, elevated respiratory rate, abnormal lung exam, elevated alanine transaminase (ALT), clearance of MERS-CoV on repeat PCR polymerase chain reaction (PCR) testing, and mycophenolate mofetil treatment. Survival was reduced in the presence of coronary artery disease, hypotension, hypoxemia, CXR (chest X-ray) abnormalities, leukocytosis, creatinine >1 · 5 mg/dL, thrombocytopenia, anemia, and renal failure. In a multivariate analysis of treatments administered, severity of illness was the greatest predictor of reduced survival.ConclusionsCare for patients with MERS-CoV remains a challenge. In this retrospective cohort, interferon beta and mycophenolate mofetil treatment were predictors of increased survival in the univariate analysis. Severity of illness was the greatest predictor of reduced survival in the multivariate analysis. Larger randomized trials are needed to better evaluate the efficacy of these treatment regimens for MERS-CoV.

A Systematic Review of therapeutic agents for the treatment of the Middle East Respiratory Syndrome Coronavirus (MERS-CoV)

“…The first group survived and the latter group died [67]. The use of interferon beta, interferon alpha, and ribavirin was associated with survival rates of 78.3%, 75%, and 68.4%, respectively [66].…”

“…One patient was treated with pegylated interferon, ribavirin and lopinavir/ritonavir and viremia was detected for two days following therapy with triple therapy [64]. In a case series, eight patients received mycophenolate mofetil and all survived [66].…”

Focus on Middle East respiratory syndrome coronavirus (MERS-CoV)

“…In contrast with animal model, the combination IFN-␤1b/MMF was administered to 8 patients in Saudi Arabia. All the patients survived but had lower APACHE II scores that other patient groups [71].…”

Diagnostic delays in Middle East respiratory syndrome coronavirus patients and health systems

“…The health-system delay in identifying a MERS-CoV case may be attributed to the delay in the virus recognition in medical institutions [6] and to the limited awareness among healthcare-workers [11], as a survey conducted on 1216 healthcare-workers revealed that only 47.6% of the physicians and 30.4% of the nurses were aware that some infected patients had no symptoms [11]. Also diagnosis of MERS-CoV [3] and medical care for patients with MERS-CoV [12] remain major challenges in healthcare facilities. Further understanding on the causes of patient and health-system delay is needed, as it can be used as a modifiable factor to reduce diagnostic delay and to improve the diagnostic process.…”