Middle East Respiratory Syndrome Coronavirus: A Case-Control Study of Hospitalized Patients

• Published in: Clinical Infectious Diseases 2014-07, Vol.59 (2), p.160-165
• Main Authors: Al-Tawfiq, Jaffar A., Hinedi, Kareem, Ghandour, Jihad, Khairalla, Hanan, Musleh, Samir, Ujayli, Alaa, Memish, Ziad A.
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; and Commentaries; ARTICLES AND COMMENTARIES; Biological and medical sciences; Case control studies; Child; Child, Preschool; Clinical Medicine - methods; Coronavirus; Coronavirus Infections - diagnosis; Coronavirus Infections - pathology; Coronavirus Infections - virology; Cough; Diagnosis, Differential; Disease control; Editor's Choice; Epidemiology; Female; Hospital admissions; Hospitalization; Human viral diseases; Humans; Infections; Infectious diseases; Male; Medical sciences; Middle Aged; Middle East Respiratory Syndrome Coronavirus - isolation & purification; Mortality rates; Pneumonia; Radiography; Symptoms; Viral diseases; Viral diseases of the respiratory system and ent viral diseases; Viruses; Young Adult
• ISSN: 1058-4838; 1537-6591
• DOI: 10.1093/cid/ciu226

Background. There is a paucity of data regarding the differentiating characteristics of patients with laboratory-confirmed and those negative for Middle East respiratory syndrome coronavirus (MERS-CoV). Methods. This is a hospital-based case-control study comparing MERS-CoV–positive patients (cases) with MERS-CoV–negative controls. Results. A total of 17 case patients and 82 controls with a mean age of 60.7 years and 57 years, respectively (P = .553), were included. No statistical differences were observed in relation to sex, the presence of a fever or cough, and the presence of a single or multilobar infiltrate on chest radiography. The case patients were more likely to be overweight than the control group (mean body mass index, 32 vs 27.8; P = .035), to have diabetes mellitus (87% vs 47%; odds ratio [OR], 7.24; P = .015), and to have end-stage renal disease (33% vs 7%; OR, 7; P = .012). At the time of admission, tachypnea (27% vs 60%; OR, 0.24; P = .031) and respiratory distress (15% vs 51%; OR, 0.15; P = .012) were less frequent among case patients. MERS-CoV patients were more likely to have a normal white blood cell count than the control group (82% vs 52%; OR, 4.33; P = .029). Admission chest radiography with interstitial infiltrates was more frequent in case patients than in controls (67% vs 20%; OR, 8.13; P = .001). Case patients were more likely to be admitted to the intensive care unit (53% vs 20%; OR, 4.65; P = .025) and to have a high mortality rate (76% vs 15%; OR, 18.96; P < .001). Conclusions. Few clinical predictors could enhance the ability to predict which patients with pneumonia would have MERS-CoV. However, further prospective analysis and matched case-control studies may shed light on other predictors of infection.