The 1-year impact of severe acute respiratory syndrome on pulmonary function, exercise capacity, and quality of life in a cohort of survivors

David S Hui, Ka T Wong, Fanny W Ko, Lai S Tam, Doris P Chan, Jean Woo, Joseph J Y Sung, David S Hui, Ka T Wong, Fanny W Ko, Lai S Tam, Doris P Chan, Jean Woo, Joseph J Y Sung

Abstract

Objective: To examine pulmonary function, exercise capacity, and health-related quality of life (HRQoL) among severe acute respiratory syndrome (SARS) survivors.

Methods: We evaluated survivors with confirmed SARS at the Prince of Wales Hospital, Hong Kong, at 3, 6, and 12 months after symptom onset. Our assessment included: lung volume (total lung capacity [TLC], vital capacity, residual volume, functional residual capacity), spirometry (FVC, FEV1), diffusing capacity of the lung for carbon monoxide (D(LCO)), inspiratory and expiratory respiratory muscle strength, 6-min walk distance (6MWD), chest radiographs (CXRs), and HRQoL by Medical Outcomes Study 36-Item Short-Form General Health Survey questionnaire.

Results: Ninety-seven patients completed the serial assessments. There were 39 male and 58 female patients, and 63 patients (70%) were health-care workers (mean age, 36.9 years [SD, 9.5 years]; body mass index, 23.7 kg/m2 [SD, 4.0 kg/m2]). At 1 year, 27 patients (27.8%) had abnormal CXR findings. Four patients (4.1%), 5 patients (5.2%), and 23 patients (23.7%) had FVC, TLC, and D(LCO) values < 80% of predicted values, respectively. The 6MWD at 12 months was 511.0 m (SD, 89.8 m), which was higher than at 3 months (mean difference, 47.0 m; 95% confidence interval [CI], 31.8 to 62.1 m; p < 0.01) but not different from 6 months (mean difference, 9.7 m; 95% CI, - 4.4 to 23.8 m; p = 0.18). The 6MWD was lower than that for normal control subjects of the same age groups, and there was impairment of HRQoL at 12 months. Patients who required ICU admission (n = 31) showed higher CXR scores (1.6 [SD, 3.1]; vs 0.4 [SD, 1.1]; p = 0.04) and lower percentage of predicted FVC, TLC, and Dlco than those who did not, but there were no differences in 6MWD and health status.

Conclusion: Significant impairment in Dlco was noted in 23.7% of survivors 1 year after illness onset. Exercise capacity and health status of SARS survivors were remarkably lower than those of a normal population.

Figures

Figure 1
Figure 1
HRQoL (SF-36) among SARS survivors at 3, 6, and 12 months after illness onset in comparison with HK normative data stratified into different age groups. The vertical axis represents SF-36 domain score in mean (SD) from 0 (minimum) to 100 (maximum), whereas the horizontal axis defines age groups in years. Based on the study by Lam et al, there were 1,244 normal subjects and 695 normal subjects in the age groups of 18 to 40 years and 41 to 64 years, respectively. There were 19 SARS survivors and 12 SARS survivors who had required ICU support in the age groups of 18 to 40 years and 41 to 64 years, whereas there were 60 SARS survivors and 19 SARS survivors who did not require ICU support in the same age groups, respectively. *Significant at p

References

    1. Zhong NS, Zheng BJ, Li YM. Epidemiology and cause of severe acute respiratory syndrome in Guangdong, People's Republic of China, in Feb 2003. Lancet. 2003;362:1353–1358.
    1. Peiris JS, Yuen KY, Osterhaus AD. The severe acute respiratory syndrome. N Engl J Med. 2003;349:2431–2441.
    1. Hui DS, Sung JJ. Severe acute respiratory syndrome [editorial] Chest. 2003;124:12–15.
    1. Peiris JSM, Chu CM, Cheng VCC. Clinical progression and viral load in a community outbreak of coronavirus-associated SARS pneumonia: a prospective study. Lancet. 2003;361:1767–1772.
    1. Cheng PK, Wong DA, Tong LK. Viral shedding patterns of coronavirus in patients with probable severe acute respiratory syndrome. Lancet. 2004;363:1699–1700.
    1. Hui DS, Wong KT, Antonio GE. Severe acute respiratory syndrome (SARS): correlation of clinical outcome and radiological features. Radiology. 2004;233:579–585.
    1. Lee N, Hui DS, Wu A. A major outbreak of severe acute respiratory syndrome in Hong Kong. N Engl J Med. 2003;348:1986–1994.
    1. Chan JW, Ng CK, Chan YH. Short term outcome and risk factors for adverse clinical outcomes in adults with severe acute respiratory syndrome (SARS) Thorax. 2003;58:686–689.
    1. Tsui PT, Kwok ML, Yuen H. Severe acute respiratory syndrome: clinical outcome and prognostic correlates. Emerg Infect Dis. 2003;9:1064–1069.
    1. Antonio GE, Wong KT, Hui DS. Thin-section CT in patients with severe acute respiratory syndrome following hospital discharge: preliminary experience. Radiology. 2003;228:810–815.
    1. Weinert CR, Gross CR, Kangas JR. Health-related quality of life after acute lung injury. Am J Respir Crit Care Med. 1997;156:1120–1128.
    1. Herridge MS, Cheung AM, Tansey CM. One-year outcomes in survivors of the acute respiratory distress syndrome. N Engl J Med. 2003;348:683–693.
    1. Schelling G, Stoll C, Vogelmeier C. Pulmonary function and health-related quality of life in a sample of long-term survivors of the acute respiratory distress syndrome. Intensive Care Med. 2000;26:1304–1311.
    1. Orme J, Jr., Romney JS, Hopkins RO. Pulmonary function and health-related quality of life in survivors of acute respiratory distress syndrome. Am J Respir Crit Care Med. 2003;167:690–694.
    1. Neff TA, Stocker R, Frey HR. Long-term assessment of lung function in survivors of severe ARDS. Chest. 2003;123:845–853.
    1. Hui DS, Joynt GM, Wong KT. The impact of severe acute respiratory syndrome (SARS) on pulmonary function, functional capacity and quality of life in a cohort of survivors. Thorax. 2005;60:401–409.
    1. Wong RS, Hui DS. Index patient and SARS outbreak in Hong Kong. Emerg Infect Dis. 2004;10:339–341.
    1. Centers for Disease Control and Prevention. Severe acute respiratory syndrome (SARS) updated interim U.S. case definition. Available at: Accessed April 20, 2003.
    1. Sung JJ, Wu A, Joynt GM. Severe acute respiratory syndrome: report of treatment and outcome after a major outbreak. Thorax. 2004;59:414–420.
    1. Weisman IM, Zeballos RJ. Clinical exercise testing. Clin Chest Med. 2001;22:679–701.
    1. American Thoracic Society statement: guidelines for the six-minute walk test. Am J Respir Crit Care Med. 2002;166:111–117.
    1. Mc Horney CA, Ware JE, Jr., Lu JF. The MOS 36-item Short-Form Health Survey (SF 36): III. Tests of data quality, scaling assumptions, and reliability across diverse patient groups. Med Care. 1994;32:40–66.
    1. Lam CL, Gandek B, Ren XS. Tests of scaling assumptions and construct validity of the Chinese (HK) version of the SF 36 health survey. J Clin Epidemiol. 1998;51:1139–1147.
    1. Lam CL, Lauder IJ, Lam TP. Population based norming of the Chinese (HK) version of the SF 36 health survey. Hong Kong Practitioner. 1999;21:460–470.
    1. Standardization of spirometry, 1994 update. American Thoracic Society. Am J Respir Crit Care Med. 1995;152:1107–1136.
    1. American Thoracic Society. Lung function testing: selection of reference values and interpretative strategies. Am Rev Respir Dis. 1991;144:1202–1218.
    1. Da Costa JL. Pulmonary function studies in healthy Chinese adults in Singapore. Am Rev Respir Dis. 1971;104:128–131.
    1. Black LF, Hyatt RE. Maximal respiratory pressures: normal values and relationships to age and sex. Am Rev Respir Dis. 1969;99:698–702.
    1. ATS/ERS Statement on respiratory muscle testing. Am J Respir Crit Med. 2002;166:518–624.
    1. Koulouris N, Mulvey DA, Laroche CM. Comparison of two different mouthpieces for the measurement of Pimax and Pemax in normal and weak subjects. Eur Respir J. 1988;1:863–867.
    1. Chan CC, Cheong TH, Wang YT. Transdiaphragmatic pressure in young adult Singaporean subjects—normal values and a comparison between different respiratory manoeuvres. Aust N Z J Med. 1996;26:75–81.
    1. Moxham J. WB Saunders; London, UK: 2000. Respiratory muscles; pp. 57–72. (Lung function tests: physiological principles and clinical applications). Hughes, JM Pride, NB eds 1st ed.
    1. Wong KT, Antonio GE, Hui DS. Severe acute respiratory syndrome: radiographic appearances and pattern of progression in 138 patients. Radiology. 2003;228:401–406.
    1. Enright PL, Sherrill DL. Reference equations for the six-minute walk in healthy adults. Am J Respir Crit Care Med. 1998;158:1384–1387.
    1. Hui DS, Sung JJ. Treatment of severe acute respiratory syndrome [editorial] Chest. 2004;126:670–674.
    1. Wong GW, Hui DS. Severe acute respiratory syndrome: epidemiology, diagnosis and treatment. Thorax. 2003;58:558–560.
    1. Wong KT, Antonio GE, Hui DS. Thin section CT of severe acute respiratory syndrome: evaluation of 73 patients exposed to or with the disease. Radiology. 2003;228:395–400.
    1. Nicholls JM, Poon LLM, Lee KC. Lung pathology of fatal severe acute respiratory syndrome. Lancet. 2003;361:1773–1778.
    1. Ding Y, Wang H, Shen H. The clinical pathology of severe acute respiratory syndrome (SARS): a report from China. J Pathol. 2003;200:282–289.
    1. Franks TJ, Chong PY, Chui P. Lung pathology of severe acute respiratory syndrome (SARS): a study of 8 autopsy cases from Singapore. Hum Pathol. 2003;34:743–748.
    1. Tse GM, To KF, Chan PK. Pulmonary pathological features in coronavirus associated severe acute respiratory syndrome (SARS) J Clin Pathol. 2004;57:260–265.
    1. Ng CK, Chan JW, Kwan TL. Six month radiological and physiological outcomes in severe acute respiratory syndrome (SARS) survivors. Thorax. 2004;59:889–891.
    1. Wong KT, Antonio GE, Hui DS. Severe acute respiratory syndrome: thin-section computed tomography features, temporal changes and clinico-radiological correlation during convalescent period. J Comput Assist Tomogr. 2004;28:790–795.
    1. Xie L, Liu Y, Fan B. Dynamic changes of serum SARS-coronavirus IgG, pulmonary function and radiography in patients recovering from SARS after hospital discharge. Respir Res. 2005;6:5.
    1. Simpson DL, Goodman M, Spector SL. Long-term follow-up and bronchial reactivity testing in survivors of the adult respiratory distress syndrome. Am Rev Respir Dis. 1978;117:449–454.
    1. Lakshminarayan S, Hudson LD. Pulmonary function following the adult respiratory distress syndrome. Chest. 1978;74:489–490.
    1. Peters JI, Bell RC, Prihoda TJ. Clinical determinants of abnormalities in pulmonary functions in survivors of the adult respiratory distress syndrome. Am Rev Respir Dis. 1989;139:1163–1168.
    1. Li AM, So HK, Chu W. Radiological and pulmonary function outcomes of children with SARS. Pediatr Pulmonol. 2004;38:427–433.
    1. Cooper AB, Ferguson ND, Hanly PJ. Long-term follow-up of survivors of acute lung injury: lack of effect of a ventilation strategy to prevent barotraumas. Crit Care Med. 1999;27:2616–2621.
    1. Li SS, Cheng CW, Fu CL. Left ventricular performance in patients with severe acute respiratory syndrome: a 30 day echocardiographic follow-up study. Circulation. 2003;108:r93–r98.
    1. Lau HM, Lee EW, Siu EH. The impact of severe acute respiratory syndrome on the physical profile and quality of life in a cohort of survivors. Arch Phys Med Rehabil. 2005;86:1134–1140.
    1. Ong KC, Ng AW, Lee LS. Pulmonary function and exercise capacity in survivors of severe acute respiratory syndrome. Eur Respir J. 2004;24:436–442.
    1. Griffith JF, Antonio GE, Kumta SM. Osteonecrosis of hip and knee in patients with severe acute respiratory syndrome treated with steroids. Radiology. 2005;236:168–175.
    1. Nava S, Fracchia G, Callegari G. Weakness of respiratory and skeletal muscles after a short course of steroids in patients with acute lung rejection. Eur Respir J. 2002;20:497–499.
    1. Kaplan PW, Rocha W, Sanders DB. Acute steroid-induced tetraplegia following status asthmaticus. Paediatrics. 1986;78:121–123.
    1. Tsai LK, Hsieh ST, Chao CC. Neuromuscular disorders in severe acute respiratory syndrome. Arch Neurol. 2004;61:1669–1673.
    1. Chua SE, Cheung V, Mc Alonan GM. Stress and psychological impact on SARS patients during the outbreak. Can J Psychiatry. 2004;49:385–390.
    1. Cheng SK, Tsang JS, Ku KH. Psychiatric complications in patients with severe acute respiratory syndrome (SARS) during the acute treatment phase: a series of 10 cases. Br J Psychol. 2004;184:359–360.
    1. Lee DT, Wing YK, Leung HC. Factors associated with psychosis among patients with severe acute respiratory syndrome: a case-control study. Clin Infect Dis. 2004;39:1247–1249.

Source: PubMed

Patrocinadores e Colaboradores

Condições médicas

Intervenções de drogas

3
Se inscrever