[Evaluation of the efficacy and safety of corticosteroid in the treatment of severe SARS in Guangdong province with multi-factor regression analysis].

ABSTRACT

OBJECTIVE: To investigate the clinical database of severe acute respiratory syndrome (SARS) in Guangdong province and evaluate the efficacy and safety of corticosteroid in the treatment of severe SARS from December 2002 to December 2003. METHODS: The detail data of 1 278 SARS patients and borderline cases were collected. Four hundred and two confirmed SARS cases were recruited in our study. Out of them, 358 cases were assigned to the severe SARS group based on the criteria issued by Ministry of Health. Subjects who received steroid (which was converted into methylprednisolone) treatment were further divided into three groups small dose group (<80 mg/day); moderate dose group (80-320 mg/day); high dose group (>or=320 mg/day). A Logistic regression model was applied to investigate the outcome variablesdeath, complications, subsequent lung infection and other infections and COX regression was made. RESULTS: (1) Small dose of steroid seemed to have protective effect, but it did not reach significant level. (2) COX regression revealed that steroid was not related to instant mortality rate. (3) Length of stay in hospital of patients steroid usage in medium dosage seemed to be 0.619 time less risky than in patients without steroid usage (chi (2)=7.262, P=0.007), and that in patients with immunomodulator (including gamma globulin, thymic peptide and interferon) was 0.671 time less risky than in patients without immunomodulator (chi (2)=10.252, P=0.001). (4)Incidence of infections in patients with steroid was 3.095 times higher than in patients without steroid (chi (2)=4.289, P=0.038). CONCLUSION: There is no significant difference in mortality, instant death incidence between steroid treatment and non-steroid treatment group of SARS patients diagnosed with the diagnostic criteria issued by Ministry of Health. However, steroid seem to shorten the length of hospital stay. But attention should be paid that infection rate could be increased in such cases.