629: KINETICS OF ANTIBODY RESPONSE IN CRITICALLY ILL PATIENTS WITH MIDDLE EAST RESPIRATORY SYNDROME

AbstractThe objective of this study is to examine the IgG antibody response in critically ill patients with the Middle East respiratory syndrome (MERS) and to examine the association of early antibody response with mortality and viral clearance. We collected blood samples from 40 consecutive real-time reverse transcription-polymerase chain reaction (rRT-PCR) confirmed critically ill MERS patients on ICU days 1, 3, 7, 14 and 28. MERS-CoV antibodies were detected by enzyme-linked immunosorbent assay (ELISA), using wells coated with MERS-CoV S1 antigen. Patients were admitted to ICU after a median (Q1, Q3) of 9 (4, 13) days from onset of symptoms with an admission Sequential Organ Failure Assessment (SOFA) score of 11 (6.5, 12). Among the study cohort, 38 patients (95%) received invasive ventilation, 35 (88%) vasopressors, 21 (53%) renal replacement therapy and 17 (43%) corticosteroids. Median (Q1,Q3) ELISA optical density (OD) ratio significantly increased with time (p < 0.001) from 0.11 (0.07, 1.43) on day 1; to 0.69 (0.11, 2.08) on day 3, 2.72 (1.84, 3.54) on day 7, 2.51 (0.35, 3.35) on day 14 and 3.77 (3.70, 3.84) on day 28. Early antibody response (day 1–3) was observed in 13/39 patients (33%) and was associated with lower mortality (hazard ratio: 0.31, 95% CI 0.10, 0.96, p = 0.04) but was not associated with faster clearance of MERS-CoV RNA. In conclusion, among critically ill patients with MERS, early antibody response was associated with lower mortality but not with faster clearance of MERS-CoV RNA. These findings have important implications for understanding pathogenesis and potential immunotherapy.

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Ribavirin and Interferon Therapy for Critically Ill Patients With Middle East Respiratory Syndrome: A Multicenter Observational Study

Clinical Infectious Diseases ◽

10.1093/cid/ciz544 ◽

2019 ◽

Vol 70 (9) ◽

pp. 1837-1844 ◽

Cited By ~ 99

Author(s):

Yaseen M Arabi ◽

Sarah Shalhoub ◽

Yasser Mandourah ◽

Fahad Al-Hameed ◽

Awad Al-Omari ◽

...

Keyword(s):

Middle East ◽

Observational Study ◽

Critically Ill ◽

Critically Ill Patients ◽

Structural Model ◽

Middle East Respiratory Syndrome ◽

Time Varying ◽

Marginal Structural Model ◽

Recombinant Interferon ◽

Multicenter Observational Study

Abstract Background The objective of this study was to evaluate the effect of ribavirin and recombinant interferon (RBV/rIFN) therapy on the outcomes of critically ill patients with Middle East respiratory syndrome (MERS), accounting for time-varying confounders. Methods This is a retrospective cohort study of critically ill patients with laboratory-confirmed MERS from 14 hospitals in Saudi Arabia diagnosed between September 2012 and January 2018. We evaluated the association of RBV/rIFN with 90-day mortality and MERS coronavirus (MERS-CoV) RNA clearance using marginal structural modeling to account for baseline and time-varying confounders. Results Of 349 MERS patients, 144 (41.3%) patients received RBV/rIFN (RBV and/or rIFN-α2a, rIFN-α2b, or rIFN-β1a; none received rIFN-β1b). RBV/rIFN was initiated at a median of 2 days (Q1, Q3: 1, 3 days) from intensive care unit admission. Crude 90-day mortality was higher in patients with RBV/rIFN compared to no RBV/rIFN (106/144 [73.6%] vs 126/205 [61.5%]; P = .02]. After adjusting for baseline and time-varying confounders using a marginal structural model, RBV/rIFN was not associated with changes in 90-day mortality (adjusted odds ratio, 1.03 [95% confidence interval {CI}, .73–1.44]; P = .87) or with more rapid MERS-CoV RNA clearance (adjusted hazard ratio, 0.65 [95% CI, .30–1.44]; P = .29). Conclusions In this observational study, RBV/rIFN (RBV and/or rIFN-α2a, rIFN-α2b, or rIFN-β1a) therapy was commonly used in critically ill MERS patients but was not associated with reduction in 90-day mortality or in faster MERS-CoV RNA clearance.

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604: AZITHROMYCIN FOR CRITICALLY ILL PATIENTS WITH MIDDLE EAST RESPIRATORY SYNDROME

Critical Care Medicine ◽

10.1097/01.ccm.0000528619.82001.34 ◽

2018 ◽

Vol 46 (1) ◽

pp. 288-288

Author(s):

Yaseen Arabi ◽

Fahad Al-Hameed ◽

Ghaleb Al Mekhlafi ◽

Anees Sindi ◽

Awad Al-Omari ◽

...

Keyword(s):

Middle East ◽

Critically Ill ◽

Critically Ill Patients ◽

Middle East Respiratory Syndrome

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Middle East Respiratory Syndrome in Critically Ill Patients with Diabetes: A Multicenter Observational Study of Clinical Presentation, Management and Outcomes

10.21203/rs.3.rs-57988/v1 ◽

2020 ◽

Author(s):

Jesna Jose ◽

Hasan Al-Dorzi ◽

Awad Al-Omari ◽

Yasser Mandourah ◽

Fahad Al-Hameed ◽

...

Keyword(s):

Regression Analysis ◽

Risk Factor ◽

Middle East ◽

Critically Ill ◽

Critically Ill Patients ◽

Independent Predictor ◽

Middle East Respiratory Syndrome ◽

Multivariable Logistic Regression Analysis ◽

Presenting Symptoms ◽

Patients With Diabetes

Abstract Background: Diabetes is a risk factor for infection with coronaviruses. This study describes the demographic, clinical data and outcomes of critically ill patients with diabetes who developed Middle East Respiratory Syndrome (MERS).Methods: This retrospective cohort study was conducted at 14 hospitals in Saudi Arabia (September 2012-January 2018). We compared the demographic characteristics, underlying medical conditions, presenting symptoms and signs, management and clinical course and outcomes between critically ill MERS patients who had diabetes and those with no diabetes. Multivariable logistic regression analysis was performed to determine if diabetes was an independent predictor of 90-day mortality.Results: Of the 350 MERS patients, 171 (48.9%) had diabetes, were more likely to be older and have comorbid conditions. Patients with diabetes were more likely to present with respiratory failure requiring intubation, vasopressors and corticosteroids. The median time to clearance of MERS-CoV RNA was similar (23 days (Q1, Q3: 17, 36) in patients with diabetes and 21.0 days (Q1, Q3: 10, 33) in patients with no diabetes. Mortality at 90 days was higher in patients with diabetes (78.9% versus 54.7%, p<0.0001). Multivariable regression analysis showed that diabetes was an independent risk factor for 90-day mortality (odds ratio, 2.09; 95% confidence interval, 1.18-3.72).Conclusions: Critically ill patients with diabetes constitute half of critically ill patients with MERS, presenting with more severe disease requiring mechanical ventilation compared to those who do not have diabetes. Diabetes is an independent predictor of mortality.

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Critically ill patients with diabetes and Middle East respiratory syndrome: a multi-center observational study

BMC Infectious Diseases ◽

10.1186/s12879-021-05771-y ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Jesna Jose ◽

◽

Hasan M. Al-Dorzi ◽

Awad Al-Omari ◽

Yasser Mandourah ◽

...

Keyword(s):

Regression Analysis ◽

Risk Factor ◽

Middle East ◽

Critically Ill ◽

Critically Ill Patients ◽

Independent Predictor ◽

Middle East Respiratory Syndrome ◽

Multivariable Logistic Regression Analysis ◽

Presenting Symptoms ◽

Patients With Diabetes

Abstract Background Diabetes is a risk factor for infection with coronaviruses. This study describes the demographic, clinical data, and outcomes of critically ill patients with diabetes and Middle East Respiratory Syndrome (MERS). Methods This retrospective cohort study was conducted at 14 hospitals in Saudi Arabia (September 2012–January 2018). We compared the demographic characteristics, underlying medical conditions, presenting symptoms and signs, management and clinical course, and outcomes of critically ill patients with MERS who had diabetes compared to those with no diabetes. Multivariable logistic regression analysis was performed to determine if diabetes was an independent predictor of 90-day mortality. Results Of the 350 critically ill patients with MERS, 171 (48.9%) had diabetes. Patients with diabetes were more likely to be older, and have comorbid conditions, compared to patients with no diabetes. They were more likely to present with respiratory failure requiring intubation, vasopressors, and corticosteroids. The median time to clearance of MERS-CoV RNA was similar (23 days (Q1, Q3: 17, 36) in patients with diabetes and 21.0 days (Q1, Q3: 10, 33) in patients with no diabetes). Mortality at 90 days was higher in patients with diabetes (78.9% versus 54.7%, p < 0.0001). Multivariable regression analysis showed that diabetes was an independent risk factor for 90-day mortality (odds ratio, 2.09; 95% confidence interval, 1.18–3.72). Conclusions Half of the critically ill patients with MERS have diabetes; which is associated with more severe disease. Diabetes is an independent predictor of mortality among critically patients with MERS.

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Macrolides in critically ill patients with Middle East Respiratory Syndrome

International Journal of Infectious Diseases ◽

10.1016/j.ijid.2019.01.041 ◽

2019 ◽

Vol 81 ◽

pp. 184-190 ◽

Cited By ~ 44

Author(s):

Yaseen M. Arabi ◽

Ahmad M. Deeb ◽

Fahad Al-Hameed ◽

Yasser Mandourah ◽

Ghaleb A. Almekhlafi ◽

...

Keyword(s):

Middle East ◽

Critically Ill ◽

Critically Ill Patients ◽

Middle East Respiratory Syndrome

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Clinical Course and Outcomes of Critically Ill Patients With Middle East Respiratory Syndrome Coronavirus Infection

Annals of Internal Medicine ◽

10.7326/m13-2486 ◽

2014 ◽

Vol 160 (6) ◽

pp. 389-397 ◽

Cited By ~ 287

Author(s):

Yaseen M. Arabi ◽

Ahmed A. Arifi ◽

Hanan H. Balkhy ◽

Hani Najm ◽

Abdulaziz S. Aldawood ◽

...

Keyword(s):

Middle East ◽

Critically Ill ◽

Critically Ill Patients ◽

Clinical Course ◽

Middle East Respiratory Syndrome ◽

Coronavirus Infection

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Critically ill patients with diabetes and Middle East respiratory syndrome: A multi-center observational study

10.21203/rs.3.rs-57988/v3 ◽

2020 ◽

Author(s):

Jesna Jose ◽

Hasan Al-Dorzi ◽

Awad Al-Omari ◽

Yasser Mandourah ◽

Fahad Al-Hameed ◽

...

Keyword(s):

Regression Analysis ◽

Risk Factor ◽

Middle East ◽

Critically Ill ◽

Critically Ill Patients ◽

Independent Predictor ◽

Middle East Respiratory Syndrome ◽

Multivariable Logistic Regression Analysis ◽

Presenting Symptoms ◽

Patients With Diabetes

Abstract Background: Diabetes is a risk factor for infection with coronaviruses. This study describes the demographic, clinical data, and outcomes of critically ill patients with diabetes and Middle East Respiratory Syndrome (MERS).Methods: This retrospective cohort study was conducted at 14 hospitals in Saudi Arabia (September 2012- January 2018). We compared the demographic characteristics, underlying medical conditions, presenting symptoms and signs, management and clinical course, and outcomes of critically ill patients with MERS who had diabetes compared to those with no diabetes. Multivariable logistic regression analysis was performed to determine if diabetes was an independent predictor of 90-day mortality.Results: Of the 350 critically ill patients with MERS, 171 (48.9%) had diabetes. Patients with diabetes were more likely to be older, and have comorbid conditions, compared to patients with no diabetes. They were more likely to present with respiratory failure requiring intubation, vasopressors, and corticosteroids. The median time to clearance of MERS-CoV RNA was similar (23 days (Q1, Q3: 17, 36) in patients with diabetes and 21.0 days (Q1, Q3: 10, 33) in patients with no diabetes). Mortality at 90 days was higher in patients with diabetes (78.9% versus 54.7%, p<0.0001). Multivariable regression analysis showed that diabetes was an independent risk factor for 90-day mortality (odds ratio, 2.09; 95% confidence interval, 1.18-3.72).Conclusions: Half of the critically ill patients with MERS have diabetes; which is associated with more severe disease. Diabetes is an independent predictor of mortality among critically patients with MERS.

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