Abstract
The most severe sequelae after rehabilitation from SARS are femoral head necrosis and pulmonary fibrosis. We performed a 15-year follow-up on the lung and bone conditions of SARS patients. We evaluated the recovery from lung damage and femoral head necrosis in an observational cohort study of SARS patients using pulmonary CT scans, hip joint MRI examinations, pulmonary function tests and hip joint function questionnaires. Eighty medical staff contracted SARS in 2003. Two patients died of SARS, and 78 were enrolled in this study from August 2003 to March 2018. Seventy-one patients completed the 15-year follow-up. The percentage of pulmonary lesions on CT scans diminished from 2003 (9.40 ± 7.83)% to 2004 (3.20 ± 4.78)% (P < 0.001) and remained stable thereafter until 2018 (4.60 ± 6.37)%. Between 2006 and 2018, the proportion of patients with interstitial changes who had improved pulmonary function was lower than that of patients without lesions, as demonstrated by the one-second ratio (FEV1/FVC%, t = 2.21, P = 0.04) and mid-flow of maximum expiration (FEF25%–75%, t = 2.76, P = 0.01). The volume of femoral head necrosis decreased significantly from 2003 (38.83 ± 21.01)% to 2005 (30.38 ± 20.23)% (P = 0.000 2), then declined slowly from 2005 to 2013 (28.99 ± 20.59)% and plateaued until 2018 (25.52 ± 15.51)%. Pulmonary interstitial damage and functional decline caused by SARS mostly recovered, with a greater extent of recovery within 2 years after rehabilitation. Femoral head necrosis induced by large doses of steroid pulse therapy in SARS patients was not progressive and was partially reversible.
Highlights
The sudden outbreak of the severe acute respiratory syndrome (SARS) virus in early 2003 disturbed the world, especially China.[1,2,3] Physicians and microbiologists have made great achievements in understanding the pathogen and effectively controlling its spread
The patients who survived had residual pulmonary fibrosis as well as osteonecrosis resulting from treatment with large doses of steroid pulse therapy
Two patients died of SARS in 2003, and seven patients declined to participate in the study
Summary
The sudden outbreak of the severe acute respiratory syndrome (SARS) virus in early 2003 disturbed the world, especially China.[1,2,3] Physicians and microbiologists have made great achievements in understanding the pathogen and effectively controlling its spread. The World Health Organization identified the source of the disease as SARS-CoV coronavirus on April 16, 2003.4–6 A total of 5327 individuals were diagnosed with SARS in China, and 349 patients died.[7] In Beijing, SARS first broke out in Peking University People’s Hospital, where 80 medical staff contracted the virus, two of whom died subsequently. This cohort became the largest patient population worldwide and was composed of healthcare workers infected during their employment. We conducted a comprehensive 15-year follow-up of healthcare workers with nosocomial SARS to evaluate their health utility after rehabilitation and obtain a new understanding of the associated pulmonary damage and femoral head necrosis
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