Critically ill healthcare workers with the middle east respiratory syndrome (MERS): A multicenter study

BackgroundMiddle East Respiratory Syndrome Coronavirus (MERS-CoV) leads to healthcare-associated transmission to patients and healthcare workers with potentially fatal outcomes.AimWe aimed to describe the clinical course and functional outcomes of critically ill healthcare workers (HCWs) with MERS.MethodsData on HCWs was extracted from a multi-center retrospective cohort study on 330 critically ill patients with MERS admitted between (9/2012–9/2015). Baseline demographics, interventions and outcomes were recorded and compared between survivors and non-survivors. Survivors were approached with questionnaires to elucidate their functional outcomes using Karnofsky Performance Status Scale.FindingsThirty-Two HCWs met the inclusion criteria. Comorbidities were recorded in 34% (11/32) HCW. Death resulted in 8/32 (25%) HCWs including all 5 HCWs with chronic renal impairment at baseline. Non-surviving HCW had lower PaO2/FiO2 ratios 63.5 (57, 116.2) vs 148 (84, 194.3), p = 0.043, and received more ECMO therapy compared to survivors, 9/32 (28%) vs 4/24 (16.7%) respectively (p = 0.02).Thirteen of the surviving (13/24) HCWs responded to the questionnaire. Two HCWs confirmed functional limitations. Median number of days from hospital discharge until the questionnaires were filled was 580 (95% CI 568, 723.5) days.ConclusionApproximately 10% of critically ill patients with MERS were HCWs. Hospital mortality rate was substantial (25%). Patients with chronic renal impairment represented a particularly high-risk group that should receive extra caution during suspected or confirmed MERS cases clinical care assignment and during outbreaks. Long-term repercussions of critical illness due to MERS on HCWs in particular, and patients in general, remain unknown and should be investigated in larger studies.

研究背景：中东呼吸综合征冠状病毒（Middle East Respiratory Syndrome Coronavirus, MERS-CoV）可引发医护人员与患者的医疗相关传播，致死风险较高。研究目的：本研究旨在描述重症MERS感染医护人员（healthcare workers, HCWs）的临床病程与功能预后。研究方法：本研究数据提取自一项多中心回顾性队列研究，该研究纳入了2012年9月至2015年9月期间收治的330例重症MERS患者，其中医护人员相关数据被单独提取。研究记录并对比了幸存者与非幸存者的基线人口学特征、临床干预措施及结局指标。向幸存者发放问卷，采用卡氏功能状态评分（Karnofsky Performance Status Scale）评估其功能预后。研究结果：共计32名医护人员符合本研究纳入标准。其中34%（11/32）的研究对象存在基础合并症；32名研究对象中8例（25%）死亡，其中包含全部5例基线存在慢性肾功能损害的医护人员。非幸存者的动脉血氧分压/吸入氧浓度比（PaO2/FiO2）中位数为63.5（四分位距：57~116.2），显著低于幸存者的148（四分位距：84~194.3），组间差异具有统计学意义（p=0.043）；且非幸存者接受体外膜肺氧合（Extracorporeal Membrane Oxygenation, ECMO）治疗的比例更高，分别为28%（9/32）与16.7%（4/24），p=0.02。24名幸存者中有13名完成了问卷回复，其中2名报告存在功能受限。从出院至完成问卷的中位时间为580天（95%置信区间：568~723.5）。研究结论：重症MERS患者中约10%为医护人员。住院病死率高达25%。存在慢性肾功能损害的患者属于极高危人群，在疑似或确诊MERS病例的临床照护排班及疫情期间应予以额外关注。MERS所致重症疾病对医护人员（尤为突出）乃至普通患者的长期影响尚未明确，需开展更大规模的研究进行深入探索。