Details about Severe Acute Respiratory Syndrome on Pulmonary Function, Exercise Capacity, and Quality of Life in a Cohort of Survivors

Patients with SARSOf the first 138 patients with SARS infection in March 2003, 15 patients (10.9%) died. Among the 123 survivors, 13 patients (10.6%) did not attend follow-up at 3 months and 6 months, whereas another 13 patients (10.6%) defaulted the 12-month assessment. Of the 13 defaulters at 12 months, 11 patients had normal lung function indexes, whereas the other 2 patients had Dlco of 68% and 78% of predicted normal values, respectively, at 6 months. Thus, there were only 97 patients (78.9%) who had completed the three assessments; among these, 63 patients (65%) were HCWs (doctors, nurses, ward assistants, and medical students) and 58 patients (66%) were women. The mean age was 36.9 years (SD, 9.5 years) and body mass index (BMI) was 23.7 kg/m2 (SD, 4.0 kg/m2) during the visit at 12 months from illness onset. The hospital length of stay (LOS) for the group was 22.7 days (SD, 14.6 days). There were only three smokers (3.3%) among the whole group. There were 15 patients with medical comorbidities, which included COPD (n = 1; 1.1%); ischemic heart disease (n = 1; 1.1%); ischemic stroke (n = 1; 1.1%); breast cancer (patient in stable clinical condition receiving tamoxifen) [n = 1; 1.1%]; diabetes mellitus (n = 3; 3.3%); cirrhosis (n = 1; 1.1%), hypertension (n = 4; 4.1%); and asymptomatic hepatitis B carrier (n = 3; 3.3%).

Among the 97 patients, 31 patients (32%; 17 men and 14 women) required ICU admission, with an ICU LOS of 13.5 days (SD, 15.6 days; median, 7 days; range, 2 to 64 days), whereas 6 patients (5.5%) required invasive mechanical ventilation. Based on our ICU admission criteria, all 31 patients would have a Pa02/fraction of inspired oxygen ratio < 300 mm Hg, whereas the 6 patients who were intubated had a Pa02/fraction of inspired oxygen ratio < 200 mm Hg. Among these 31 patients, 6 patients had medical comorbidities, including ischemic heart disease (n = 1; 0.9%), diabetes mellitus (n = 1; 0.9%), hypertension (n = 2; 1.8%), and asymptomatic hepatitis B carrier (n = 2; 1.8%), but none had any history of smoking or pulmonary disease. Treat pulmonary diseases together with medications of Canadian Health&Care Mall.

Lung Function Tests and Respiratory Muscle Strength

An overview of the serial lung function tests and respiratory muscle strength results for the group are shown in Table 1. Overall, lung volume parameters and surface area for exchange were well preserved at 3, 6, and 12 months. There was significant reduction in Dlco, FEF25 75, and alveolar volume (Va), whereas there was an increase in Kco over the study period of 12 months. Plmax and PEmax values < 80 cm H2O were noted in 16 patients (14.5%) and 8 patients (7.3%), respectively, at 12 months.

6 min walk testThe frequency of SARS survivors with lung function parameters < 80% of predicted values is as follows: 3 months, FEV1 (n = 3; 3.1%), FVC (n = 6; 6.2%), VC (n = 6; 6.2%), TLC (n = 7; 7.3%), Dlco (n = 13; 13.5%), and Kco (n = 2; 2.1%); 6 months, FEV1 (n = 4; 4.1%), FVC (n = 4; 4.1%), VC (n = 5; 5.2%), TLC (n = 8; 8.2%), Dlco (n = 15; 15.5%), and Kco (n = 1; 1.0%); and 12 months, FEVj (n = 5; 5.2%), FVC (n = 4; 4.1%), VC (n = 5; 5.2%), TLC (n = 5; 5.2%), Dlco (n = 23; 23.7%), and Kco (n = 0; 0%). Thus, there were 23 patients (23.7%) with impaired Dlco, whereas up to 5.2% of patients had reduction in parameters of lung volume at 12 months.

6MWD

The mean 6MWD increased significantly, from 464 m (SD, 87 m) at 3 months to 502 m (SD, 97 m) and 511 m (SD, 90 m) at 6 months and 12 months, respectively (p value for trend < 0.01). When the subjects were stratified into different age groups and compared to the corresponding normative values, their exercise capacity was generally significantly lower than the normal subjects (Table 2). The 6MWDs of the SARS survivors at 3, 6 and 12 months, in comparison with normative data, are shown in Table 3.

Determinants of 6MWD

Univariate followed by multivariate analyses, controlled for age and gender, were performed to look for factors associated with 6MWD (Table 3). At 3 months, there was no independent predictor identified, whereas percentage of predicted FVC was the only positive independent predictor for 6MWD at 6 months. At 12 months, the independent positive predictors for 6MWD were percentage of predicted FVC and percentage of predicted Dlco.

CXR and Correlations With Lung Function and 6MWD

Thirty-seven patients (38.1%) were noted to have abnormal total CXR scores at 3 months involving 3.9% (SD, 3.5%; range, 0.5 to 15%) of the total lung fields, whereas 32 patients (33%) had abnormal CXR scores involving 3.1% (SD, 3.4%; range, 0.8 to 15%) of the lung fields at 6 months. At 1 year, 27 patients (27.8%) had abnormal CXR findings involving 2.9% (SD, 3.1%; range, 0.8 to 15%) of lung fields. By repeated-measures ANOVA analysis of patients with abnormal CXR scores (n = 37), there was a significant trend for improvement from 3 to 12 months (p = 0.001).

lactate dehydrogenase Correlations between the extent of CXR abnormality vs cumulative steroid dosage, lung function parameters, and 6MWD at 12 months were examined. There was a significant positive correlation between the extent of radiographic abnormalities (percentage of lung fields) and the cumulative hydrocortisone dosage (r = 0.43, p < 0.01). There were significant negative correlations between the extent (percentage) of radiographic abnormalities and TLC (r = — 0.25, p = 0.01) and Dlco (r = — 0.37, p < 0.01). However, no significant correlations were noted between the extent of radiographic abnormalities vs 6MWD (r = — 0.14, p = 0.17), FEV1 (r =— 0.08, p = 0.42), RV (r = — 0.21, p = 0.05), FVC (r = — 0.19, p = 0.06), Kco (r = — 0.16, p = 0.11), Plmax (r =— 0.02, p = 0.88), and PEmax (r = 0.09, p = 0.41).

Comparison of Patients Who Required ICU Support vs Those Who Were Treated on the Medical Wards

Patients who had required ICU admission (n = 31; 17 men and 14 women) had a higher peak lactate dehydrogenase (LDH) level, a higher peak C-reactive protein (CRP) level, a longer hospital LOS, and received a significantly higher total steroid dose than those who did not require ICU care (Table 4). The lung function tests at 12 months showed significantly lower percentage of predicted FVC, VC, TLC, RV, and Dlco in survivors who required ICU support than those who were treated on medical wards, although no significant difference was noted for 6MWD and respiratory muscle strength between the two groups (Table 5).

Health Status Among SARS Survivors and Its Correlation With Lung Function Parameters

By repeated-measures ANOVA of the serial scores of the eight SF-36 domains for the entire cohort over 12 months, there were significant trends for mean improvement in RP of 37.6 (SD, 39.7), 61.1 (SD, 43.8), and 58.5 (SD, 43.0) at 3, 6, and 12 months, respectively [p for trend < 0.001]; SF of 63.4 (SD, 25.0), 72.4 (SD, 22.5), and 68.9 (SD, 25.1) at 3, 6, and 12 months, respectively [p for trend 0.001]; and RE of 51.6 (SD, 43.8), 68.4 (SD, 39.5), and 63.6 (SD, 42.8) at 3, 6, and 12 months, respectively [p for trend < 0.001], whereas there was worsening of GH: 53.4 (SD, 19.7), 51.5 (SD, 19.2), and 49.1 (SD, 19.1) at 3, 6, and 12 months, respectively (p for trend 0.023), There were no significant serial changes in PF, BP, VT, and MH (data not shown).

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Lung FunctionCorrelations between lung function parameters, 6MWD, and SF-36 domains at 12 months are shown in Table 6. In general, there were significant positive correlations between lung function parameters (FVC, VC, FEV1, and Dlco) with several SF-36 domains (PF, RP, GH, SF, and RE). 6MWD had significant positive correlations with all SF-36 domains except MH.

SF-36 domain scores at 3, 6, and 12 months after illness onset in patients who did and did not require ICU support during the acute illness in comparison to normative data are shown in Figure 1 (more data are available only in on-line supplemental Tables 7-9). There was significant impairment of health status among our SARS survivors at 12 months compared to control subjects of the same age groups. People of all age may place an order fro drugs via Canadian Health&Care Mall.

When directly comparing those who had required ICU admission against those treated on the medical wards, there was no significant difference in all SF-36 domains between the two groups at 12 months. When comparing the 25 patients who did not require intubation in ICU against those who had required intubation (n = 6), the latter had more severe lung injury, as reflected by a higher peak LDH level: median, 466.0 U/L (interquartile range [IQR, 259.0 U/L]) vs 652.0 U/L (IQR, 124.5 U/L) [p = 0.02]. There was, however, no statistically significant difference with regard to age (36.0 years [IQR, 15.5 years] vs 36.5 years [IQR, 17.5 years], p = 0.87) and 6MWD (538.5.7 m [IQR, 170.2 m] vs 548.3 m [IQR, 118.1 m]; p = 0.71) at 12 months. In addition, there were no significant differences between the two groups with regard to lung function indexes and SF-36 domain scores at 12 months (data available only in on-line supplemental Table 10).

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Fig1
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 < 0.01. **Significant at p < 0.03. #Significant at p < 0.05. mth = month.
Table 1—Results of Serial Pulmonary Function Tests and Respiratory Muscle Strength Among SARS Survivors (n = 97)

Parameters 3 mo 6 mo 12 mo
FVC, % of predicted 102.8 (14.0) 103.6 (14.5) 104.1 (14.7)
FEVb % of predicted 107.5 (14.6) 106.8 (14.9) 106.5 (14.9)
FEF25-75, % of predicted 96.0 (25.6) 90.0 (27.7) 87.7 (26.4)t
TLC, % of predicted 104.5 (18.0) 106.0 (16.7) 105.8(16.1)
VC, % of predicted 103.1 (14.5) 103.5 (14.9) 103.7 (15.3)
RV, % of predicted 106.3 (48.6) 110.6(43.2) 109.7 (38.3)
Dlco, % of predicted 95.9(17.2) 95.5 (19.4) 91.8 (17.7){
Kco, % of predicted 107.1 (14.4) 110.9(14.3) 114.0 (14.5)§
Va, L 4.5 (1.1) 4.3 (1.1) 4.1 (1.1)|
Plmax, % of predicted 108.7 (29.8) 107.0(28.1) 109.5 (28.3)
PEmax, % of predicted 73.6 (17.4) 74.6 (19.7) 74.6 (18.9)

Table 2—(>MWD Among SARS Survivors (n = 97) at 3, 6, and 12 Months After Illness Onset in Comparison With HK Normative Data

6MWD, m
Variables Normal, Mean (SD) 3 mo. Mean (SD): Mean Д (95% CI) 6 mo. Mean (SD): Mean Д (95% CI) 12 mo. Mean (SD): Mean Д (95% CI)
Survivors (n = 97) tAge group 21 to 30 yr (n = 29) NA 464 (87): NA 502 (97): NA 511 (90): NA
Men 651 (105): [n = SO] 493 (53): – 158 (- 195 to – 121) [n = 14] j: 543 (72): – 108: – 166 to – 50: [n = 14] \ 538 (39): – 113 (- 145 to – 81 m) [n = 14] \
Women Age group 31 to 40 yr (n = 40) 600 (84): [n = 85] 454 (85): – 146 (- 193 to – 99) [n = 15] j: 490 (99): – 110 (- 158 to – 62) [n = 15] j: 516(89): – 84 (- 131 to – 37) [n = 15] j:
Men 645 (93) [n = 78] 513 (82): – 132 (- 180 to – 85) [n = 18] j; 551 (98): – 94 (- 143 to – 45) [n = 18] j: 561 (89): – 84 (- 132 to – 36) [n = 18] j:
Women Age group 41 to 50 yr (n = 19) 606 (86) [n = 108]) 480 (70): – 126 (- 164 to – 87) [n = 22] j: 507 (49): – 99 (- 126 to – 72) [n = 22] j: 514(55): – 92 (- 121 to – 62) [n = 22] j:
Men 623 (80) [n = 38] 488 (88): – 135 (- 213 to – 58) [n = 14] j; 544(132): – 79 (- 247 to 89) [p = 0.26: n = 5] 542(97): – 81 (- 160 to – 29) [n = 5]||
Women Age group 51 to 60 yr (n = 9) 541 (67) [n = 79] 395 (78): – 146 (-187 to -105) [n = 14] j; 468(78): – 73 (- 114 to – 32) [n = 14] j: 467 (104): – 74 (- 136 to – 12) [n = 14] §
Men 588 (68) [n = 23] 331 (83): – 257 (- 361 to – 152) [n = 2]f 405 (89): – 183 (- 289 to – 78) [n = 2]f 459 (178): – 129 (- 1,727 to 1,469) [NS: n = 2]
Women 534 (89) [n = 33] 405 (98)- 129 (- 205 to – 53) [n = 7]| 362 (109): – 172 (- 250 to – 94) [n = 7]| 401 (92): – 133 (- 208 to – 58) [n = 7]t

Table 3—Predictors of 6MWD at 3, 6, and 12 Months From Symptom Onset (n = 97)

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Predictors 3 mo 6 mo 12 mo
UnivariateAnalysis SE Multivariate Analysis (Adjusted R2 = 0.16) SE UnivariateAnalysis SE Multivariate Analysis (Adjusted R2 = 0.31) SE UnivariateAnalysis SE Multivariate Analysis (Adjusted R2 = 0.34) SE
BMI
P coefficient — 2.679 1.896 — 3.560 2.375 — 3.433 2.261
p Value 0.161 0.137 0.132
Total steroid dose
P Coefficient 0.000 0.001 0.000 0.001 0.000 0.001
p Value 0.674 0.690 0.697
LOS
P Coefficient — 1.773 0.578 — 1.065 0.681 — 1.460 0.659 0.244 0.675 — 0.989 0.623
p Value 0.003 0.122 0.029 0.719 0.116
ICU
P Coefficient — 9.124 19.047 27.001 20.866 28.048 19.447
p Value 0.633 0.199 0.153
Baseline LDH
P Coefficient — 0.005 0.053 0.077 0.057 0.040 0.053
p Value 0.923 0.181 0.446
Peak LDH
P Coefficient — 0.003 0.051 0.091 0.056 0.034 0.052
p Value 0.958 0.105 0.508
Peak CRP
P Coefficient 0.212 0.183 0.313 0.218 0.052 0.181
p Value 0.251 0.155 0.776
FVC % predicted P Coefficient 1.786 0.605 0.100 1.26 3.399 0.585 2.452 1.193 2.773 0.561 2.863 1.021
p Value 0.004 0.937 0.000 0.043 0.000 0.007
FEVj % predicted P Coefficient 1.643 0.581 0.667 0.937 3.000 0.586 0.127 1.097 1.942 0.586 — 1.593 0.954
p Value 0.006 0.545 0.000 0.908 0.001 0.098
Dlco % predicted P Coefficient 0.78 0.505 1.842 0.472 0.454 0.541 2.439 0.457 1.216 0.522
p Value 0.126 0.000 0.404 0.000 0.022
Kco % predicted P Coefficient — 0.381 0.603 0.140 0.626 — 0.079 0.636
p Value 0.530 0.823 0.901
Total CXR score
P Coefficient — 2.964 2.988 — 5.808 4.040 — 6.112 4.407
p Value 0.324 0.154 0.169

Table 4—Comparison of Demographics, Biochemical Markers, and Steroid Dosage in SARS Survivors Who Required ICU Support vs Those Treated on Medical Wards

Variables ICU (n = 31) No ICU (n = 66) 95% CI Between Groups; p Value
Age, yr 38.4 (9.8) 35.0 (9.2) – 0.7 to 7.5; 0.10
Male gender, No. 17 22 p = 0.05
BMI at 3 mo, kg/m2 24.0 (3.8) 22.6 (4.9) – 0.6 to 3.4; 0.18
BMI at 6 mo, kg/m2 24.3 (3.8) 23.1 (4.2) – 0.6 to 3.0; 0.18
BMI at 12 mo, kg/m2 24.6 (3.6) 23.2 (4.2) – 0.4 to 3.1; 0.12
Hospital LOS, d 32.4 (19.8) 18.1 (8.3) 6.9 to 21.8; < 0.01f
CRP baseline, mg/dL 26.4 (28.1) 20.1 (27.4) – 6.8 to 19.4; 0.34
CRP peak, mg/dL 77.1 (61.6) 33.3 (37.3) 18.7 to 70.0; < 0.01f
LDH baseline, U/L 357.8 (201.3) 283.4 (164.4) – 6.2 to 154.9; 0.07
LDH peak, U/L 522.3 (157.0) 349.6 (169.6) 97.6 to 247.7; < 0.01т
Cumulative steroid dosage (hydrocortisone), mg 18,881 (11,425) 7,805 (6,200) 6,646 to 15,506; < 0.01f
CXR total score at 12 mo, % mo 1.6 (3.1) 0.4 (1.1) 0.04 to 2.4; 0.04т

Table 5—Comparison of Lung Function Indexes, Respiratory Muscle Strength, and 6MWD in SARS Survivors Who Required ICU Care (n = 31) vs Those Treated on Medical Wards (n = 66)

Variables ICU/No ICU
3 mo 6 mo 12 mo
FVC, % of predicted 94.3 (14.0)/106.8 (12.2); 7.0 to 18.0; < 0.01т 98.6 (15.8)/106.0 (13.3); 1.3 to 13.5; 0.02т 98.5 (13.6)/106.8 (14.5); 2.1 to 14.4; 0.01т
FEVb % of predicted 102.0 (13.1)/110.0 (14.7); 1.8 to 14.1; 0.01т 103.8 (12.7)/108.2 (15.7); — 2.0 to 10.8; 0.18 103.8 (11.5)/107.7 (16.2); — 2.6 to 10.3; 0.23
VC, % of predicted 94.7 (15.1)/107.0 (12.5); 6.4 to 18.1; < 0.01т 98.4 (16.4)/105.8 (13.6); 1.0 to 13.8; 0.02т 98.8 (16.2)/106.0 (14.5); 0.6 to 13.7; 0.03т
TLC, % of predicted 94.6 (16.1)/109.0 (17.2); 7.0 to 21.7; < 0.01т 98.2 (19.3)/109.6 (14.1); 3.4 to 19.3; 0.01т 96.3 (14.3)/110.1 (15.0); 7.3 to 20.2; < 0.01т
RV, % of predicted 96.7 (39.4)/110.7 (51.9); — 7.2 to 35.1; 0.19 99.9 (51.6)/115.5 (38.2); — 5.6 to 36.8; 0.15 93.3 (36.1)/117.2 (37.1); 7.8 to 40.0; < 0.01т
Dlco, % of predicted 84.3 (17.5)/101.4 (14.1); 10.5 to 23.7; < 0.01т 87.7 (21.0)/99.1 (17.6); 3.3 to 19.5; 0.01т 85.0 (21.0)/93.8 (18.6); 0.4 to 17.2; 0.04т
Kco, % of predicted 104.9 (13.5)/108.1 (14.7); — 3.0 to 9.4; 0.31 109.4 (15.3)/111.6 (13.9); — 4.1 to 8.3; 0.49 116.0 (13.8)/113.1 (14.8); — 9.2 to 3.4; 0.36
Plmax, % of predicted 104.2 (29.1)/110.7 (30.1); — 6.5 to 19.6; 0.32 105.6 (30.6)/107.7 (27.0); — 10.1 to 14.3; 0.73 102.6 (29.7)/112.8 (27.3); — 1.9 to 22.3; 0.10
PEmax, % of predicted 75.7 (14.9)/72.7 (18.5); — 10.6 to 4.7; 0.44 74.5 (19.1)/74.6 (20.1); — 8.5 to 8.6; 0.99 74.9 (21.1)/74.4 (17.9); — 8.7 to 7.7; 0.91
6MWD, m 458.2(86.8) vs 467.3(86.4); —28.7 to 46.9, p = 0.63 519.7(101.4) vs 492.7(93.2); —68.4 to 14.4, p = 0.20 530.1(83.5) vs502.0(91.9); —66.7 to 10.6, p = 0.15

Table 6—Correlations Among HRQoL, Pulmonary Function, and 6MWS at 12 Months (n = 97)

SF-36Domains FVC FEVj VC TLC Dlco 6MWD
PF 0.31t 0.30t 0.33t 0.13 0.32t 0.52t
RP 0.22j 0.27t 0.24{ 0.06 0.22§ 0.37t
BP 0.13 0.09 0.19 0.04 0.09 0.27J
GH 0.41t 0.32t 0.41t 0.26t 0.31t 0.43t
VT 0.21§ 0.16 0.23j 0.07 0.16 0.25t
SF 0.21§ 0.24{ 0.25t 0.03 0.21§ 0.30t
RE 0.28t 0.21§ 0.29t 0.09 0.25J 0.40t
MH 0.15 0.18 0.16 0.06 0.12 0.08

Table 7—Correlations of CXR Scores vs Steroid Dosage, 6MWD, and Lung Function Test Parameters at 12 Months (n = 97)

Variables CXR Score of Airspace Consolidation CXR Score of Reticular Shadows CXR Sum of Airspace and Reticular Shadows
Hydrocortisone cumulative dosage r — 0.09; p = 0.39 r = 0.54; p < 0.01* r = 0.43 p < 0.01*
6 mwd r = 0.02; p = 0.85 r — 0.17; p = 0.09 r — 0.14 p = 0.17
FVC % of predicted r = 0.09; p = 0.37 r — 0.27; p = 0.01* r — 0.19 p = 0.06
FEV1 % of predicted r = 0.06; p = 0.59 r — 0.13; p = 0.22 r — 0.08 p = 0.42
VC % of predicted r = 0.13; p = 0.22 r — 0.28; p = 0.01* r — 0.17 p = 0.10
TLC % of predicted r — 0.10; p = 0.31 r — 0.23; p = 0.03* r — 0.25 p = 0.01 *
RV % of predicted r — 0.21; p = 0.04* r — 0.10; p = 0.31 r — 0.21 p = 0.05
Dlco % of predicted r — 0.03; p = 0.81 r — 0.41; p < 0.01 * r — 0.37 p < 0.01*
Kco % of predicted r — 0.22; p = 0.04* r — 0.06; p = 0.55 r — 0.16 p = 0.11
Plmax % of predicted r — 0.08; p = 0.46 r = 0.03; p = 0.80 r — 0.02 p = 0.88
PEmax % of predicted r — 0.04; p = 0.70 r = 0.12; p = 0.24 r = 0.09 p = 0.41

Table 8—HRQoL (SF-36) Among SARS Survivors (n = 31) Who Required ICU Admission, at 3, 6, and 12 Months After Illness Onset in Comparison With HK Normative Data Stratified Into Different Age Groups

SF-36 Domains/ Age Group, yr Normal, Mean (SD) 3 mo vs Normal, Mean (SD): Mean Д (95% CI) 6 mo vs Normal, Mean (SD): Mean Д (95% CI) 12 mo vs Normal,Mean (SD): Mean Д (95% CI)
PF18-4041-64 96.3 (6.6) 90.6(12.4) 82.4 (14.6): – 13.9 (- 20.9 to – 6.9)f 68.3 (21.5): – 22.3 (- 36.0 to – 8.6)f 87.1 (10.0): – 9.1 (- 14.0 to – 4.3)f 72.9 (24.1): – 17.7 (-33.0 to – 2.4)§ 86.8 (11.0): – 9.4 (- 14.7 to – 4.1)f 74.2 (22.0):– 16.5 (- 30.5 to – 2.4) j:
RP18-4041-64 85.6 (27.7) 81.6(31.7) 30.3 (35.9): – 55.3 (- 72.7 to – 37.9)f 12.5 (29.2): – 69.1 (- 87.2 to – 51.0)f 76.3(30.6): – 9.3 (- 21.8 to 3.3) [NS] 27.1 (37.6): – 54.5 (- 72.7 to – 36.4)t 80.3 (31.9): – 5.3 (- 17.9 to 7.2) [NS] 47.9 (48.2): – 33.7 (- 64.5 to – 3.0)§
BP18-4041-64 86.4(19.4) 82.6 (22.9) 71.0 (27.5): – 15.3 (- 28.7 to – 2.1)j: 64.2 (31.7): – 18.4 (- 38.7 to 1.9) [NS] 73.7 (22.1): – 12.7 (- 21.5 to – 3.8)t 69.1 (27.7): – 13.5 (- 26.7 to – 0.4)§ 71.5    (24.8): – 14.8 (- 26.9 to – 2.8) j:62.6    (28.1): – 20.0 (- 33.2 to – 6.9)t
GH18-4041-64 59.5 (19.4) 53.2 (20.1) 55.6 (20.3): – 3.9 (- 12.7 to 4.9) [NS] 44.1 (18.4): – 9.2 (- 20.6 to 2.3) [NS] 52.4 (15.1): – 7.1 (- 15.9 to 1.6) [NS] 49.7 (20.8): – 3.6 (- 15.1 to 7.9) [NS] 48.4 (15.1): 11.1 (- 19.8 to – 2.3) j: 47.1 (22.0): – 6.2 (- 17.7 to 5.4) [NS]
VT18-4041-64 60.2 (18.3) 60.3(18.9) 50.3 (8.3): 9.9 (- 14.0 to – 5.8) f 46.7 (10.3): – 13.7 (- 20.3 to – 7.0)f 50.5(11.4): 9.7 (— 15.2 to – 4.1)f 47.9 (12.3): – 12.4 (23.1 to – 1.7) j: 44.0 (15.5): – 16.2 (- 24.5 to 8.0) t 46.3 (15.1): 14.1 (- 24.8 to – 3.3) j:
SF18-4041-64 90.2 (16.2) 92.4 (16.5) 57.2    (26.5): 33.0 (- 45.8 to 20.2)f58.3    (25.2): 34.1 (- 50.2 to – 18.1)r 77.6 (16.4): 12.6 (- 20.0 to 5.3)f 70.8 (22.2): – 21.6 (- 31.1 to – 12.1)r 72.4 (24.1): [17.9 (- 29.6 to – 6.2)f 70.8 (27.9): – 21.6 (- 39.4 to – 3.8) j:
RE18-4041-64 67.7 (39.4) 75.0 (37.0) 54.4    (43.3): – 13.4 (- 31.2 to 4.5) [NS]19.4    (30.0): 55.5 (- 76.6 to 34.4)f 82.5(25.7): 14.7 (2.1 to 27.3) j: 47.2 (48.1): 27.2 (- 49.0 to 6.5) j: 71.9 (42.0): 4.2 (-13.7 to 22.1) [NS] 55.6 (43.4): – 19.4 (- 40.6 to 1.8) [NS]
MH18-4041-64 71.8(15.6) 73.1 (17.6) 63.6 (13.9): 8.7 (- 15.7 to 1.6) j: 61.0 (20.1): – 12.1 (- 22.1 to – 2.0) j: 67.8 (12.8): – 4.0 (- 11.1 to 3.0) [NS] 68.3 (19.0): – 4.7 (- 14.8 to 5.3) [NS] 63.4 (18.3): – 8.5 (- 15.6 to – 1.4) j: 66.3 (20.6): – 6.7 (- 16.8 to 3.4) [NS]
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Table 9—HRQoL (SF-36) Among SARS Survivors (n = 66) Who Did Not Require ICU Admission at 3, 6, and 12 Months After Illness Onset in Comparison With K Normative Data Stratified Into Different Age Groups

SF-36 Domains/ Age Groups Normal, Mean (SD) 3 mo vs Normal, Mean (SD): Mean Д (95% Cl) 6 mo vs Normal, Mean (SD): Mean Д (95% Cl) 12 mo vs Normal, Mean (SD): Mean Д(95% Cl)
PF18-4041-64 96.3 (6.6) 90.6(12.4) 84.8(15.8): – 11.5 (- 16.0 to – 7.0)t 60.6 (24.6): – 30.0 (- 43.2 to – 16.8) f 84.1    (16.5): – 12.2 (- 16.9 to – 7.4)f64.1    (25.6): – 26.6 (- 40.2 to – 12.9)f 83.6 (18.4): – 12.7 (- 17.9 to – 7.4)f 60.3 (28.1): – 30.3 (- 45.3 to – 15.3)t
RP18-4041-64 85.6 (27.7) 81.6(31.7) 49.5 (41.8): – 36.1 (- 48.1 to – 24.1) f 28.1 (32.8): – 53.5 (- 69.3 to – 37.7) f 74.0    (40.7): – 11.6 (- 23.3 to 0.1) [NS]28.1    (41.7): – 53.5 (- 75.9 to – 31.1)t 61.0 (40.8): – 24.6 (- 35.3 to – 12.9)t 32.8 (41.6): – 48.8 (- 71.1 to – 26.5)t
BP18-4041-64 86.4(19.4) 82.6 (22.9) 79.4 (22.2): – 7.0 (- 12.5 to – 1.4) j: 42.9 (18.7): – 39.7 (- 51.0 to – 28.3) t 70.5 (25.8): – 15.9 (- 23.3 to – 8.5)f 47.7 (24.9): – 34.9 (- 46.3 to – 23.5) f 66.6 (23.0): – 19.7 (- 26.4 to – 13.1)t 48.9 (29.8): – 33.8 (- 49.7 to – 17.8)f
GH18-4041-64 59.5 (19.4) 53.2 (20.1) 58.9 (19.4): – 0.6 (- 6.1 to 4.9) [NS] 40.3 (11.6): – 13.0 (- 19.3 to – 6.7)f 56.4 (18.8): – 3.1 (- 8.6 to 2.3) [NS] 36.3 (16.5): – 16.9 (- 26.9 to – 7.0)f 54.2 (18.7): – 5.3 (- 10.7 to 0.2) [NS] 35.4 (16.2): – 17.9 (- 27.8 to – 7.9)f
VT18-4041-64 60.2 (18.3) 60.3(18.9) 49.1 (11.2): – 11.1 (- 14.4 to – 7.8)f 39.7 (9.6): – 20.6 (- 25.9 to – 15.4)f 49.5 (11.2): – 10.7 (- 14.0 to – 7.4)f 38.1 (15.5): – 22.2 (- 31.5 to – 12.9)t 48.4 (12.8): – 11.8 (- 15.6 to – 8.0)f 38.8 (13.8): – 21.6 (- 30.9 to – 12.2)t
SF18-4041-64 90.2 (16.2) 92.4(16.5) 70.0 (22.9): – 20.3 (- 26.8 to – 13.7) f 53.9 (25.7): – 38.5 (- 52.3 to – 24.8)f 75.0(20.8): – 15.3 (- 21.2 to -9.3)f 59.4 (29.8): – 33.0 (- 49.0 to – 17.1)t 72.8 (23.1): – 17.5 (- 24.1 to – 10.9) t 51.6 (25.0): – 40.9 (- 54.2 to – 27.5)t
RE18-4041-64 67.7 (39.4) 75.0 (37.0) 66.0    (41.8): – 1.7 (- 12.9 to 9.4) [NS]27.1    (38.9): – 47.9 (- 66.3 to – 29.5)f 76.0 (34.4): 8.3 (- 2.8 to 19.4) [NS] 43.8 (46.7): – 31.2 (- 49.7 to – 12.7)t 68.0 (40.9): 0.3( – 10.9 to 11.4) [NS] 45.8 (46.9): – 29.1 (- 47.6 to – 10.7)t
MH18-4041-64 71.8(15.6) 73.1 (17.6) 69.6 (16.9): – 2.2 (- 6.7 to 2.2) [NS] 48.8 (16.3): – 24.3 (- 33.0 to – 15.6)t 67.0 (15.1): – 4.8 (-9.2 to – 0.4)§ 52.0 (18.7): – 21.1 (- 29.8 to – 12.3)t 67.2 (18.8): – 4.6 (- 10.0 to 0.8) [NS] 58.8 (18.8): – 14.3 (- 23.1 to – 5.6)f

Table 10—Comparison of Age and LDH Levels During Hospitalization and Outcome at 12 Months Between Patients Who Required Invasive Ventilatory Support (n = 6) vs Those Not Requiring Intubation in the ICU (n = 25)

Variables Intubated (n = 6) Not Intubated (n = 25) p Value
Age, yr 36.5 (17.5) 36.0 (15.5) 0.84
Baseline LDH, U/L 500.5 (510.8) 243.0 (187.0) 0.39
Peak LDH, U/L 652.0 (124.5) 466.0 (259.0) 0.02t
6MWD, m 548.3(118.1) 538.5 (170.2) 0.71
FVC, % predicted 96.5 (15.8) 100.0 (17.5) 0.84
FEVb % predicted 100.5 (13.5) 108.0 (15.0) 0.82
TLC, % predicted 96.0(15.5) 98.5 (22.8) 0.86
VC, % predicted 99.0 (22.0) 96.5 (19.8) 0.60
RV, % predicted 89.5 (20.5) 93.5 (57.3) 0.80
Dlco, % predicted 79.0 (36.8) 92.0 (23.0) 0.25
Kco, % predicted 112.5 (25.8) 118.0(16.0) 0.44
Plmax, % predicted 115.5 (63.0) 102.0 (39.0) 0.34
PEmax, % predicted 74.5 (51.3) 77.0 (27.0) 0.69
PF 90.0(12.5) 85.0(17.5) 0.70
RP 100.0 (62.5) 100.0 (87.5) 0.69
BP 74.0 (18.5) 74.0 (46.0) 0.39
GH 47.0 (24.3) 40.0 (25.0) 0.42
VT 45.0 (22.5) 45.0 (22.5) 0.40
SF 81.3 (43.8) 75.0 (50.0) 0.94
RE 83.3 (75.0) 100.0 (83.3) 0.98
MH 80.0 (38.0) 60.0 (30.0) 0.24
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