Abstract
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.
Highlights
Middle East Respiratory Syndrome Coronavirus (MERS-CoV) is a beta coronavirus that was first recovered from a patient who died of a fatal pneumonia and multi-organ failure in 2012 [1, 2]
A total of 32 critically ill health care workers (HCWs) were admitted to ICU with MERS during the study period
Our study demonstrates that hospital mortality among critically ill HCWs with MERS was substantial [25% (8/32)], but lower that what has been reported in general ICU MERS patients
Summary
Middle East Respiratory Syndrome Coronavirus (MERS-CoV) is a beta coronavirus that was first recovered from a patient who died of a fatal pneumonia and multi-organ failure in 2012 [1, 2]. A number of published cohort studies highlighted the variable clinical presentation of MERS, which ranges between minimal or no symptoms and severe, potentially fatal pneumonia that often complicates with multi-organ failure[2,3,4,5]. The majority of MERS cases were reported from Saudi Arabia and were linked to healthcare outbreaks[6] This is most likely related to the overcrowding in emergency departments, lack of diligent application of proper infection control practices, and effective nosocomial transmission[6, 7]. Middle East Respiratory Syndrome Coronavirus (MERS-CoV) leads to healthcare-associated transmission to patients and healthcare workers with potentially fatal outcomes
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