SARS in Singapore - Predictors of disease severity

Hoe Nam Leong, Arul Earnest, Hong Huay Lim, Chee Fang Chin, Colin S.H. Tan, Mark E. Puhaindran, Alex C.H. Tan, Mark I.C. Chen, Yee Sin Leo

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Introduction: Severe acute respiratory syndrome (SARS) affected 8096 individuals in 29 countries, with 774 deaths. In Singapore, there were 238 cases of SARS with 33 deaths. A retrospective analysis was performed to identify predictors of poor outcome in patients with SARS locally. Materials and Methods: Clinical, laboratory and outcome data of 234 patients admitted to Tan Tock Seng Hospital and Singapore General Hospital were collected and analysed. Only data collected at the time of admission were used in the analysis for predictors of poor outcome. Adverse events were defined as admission to the intensive care unit or death. Results: Clinical (temperature, FiO2) and laboratory [leukocyte, lymphocyte, neutrophil, platelet, lactate dehydrogenase (LDH), albumin] trends in groups with and without an adversarial event were presented. Fifty patients experienced an adverse event. On univariate analysis, male gender, advanced age, presence of comorbidities, neutrophilia, lymphopaenia, hyponatraemia, hypoalbuminaemia, transaminitis and elevated LDH or C-reactive protein were found to be significant predictors. On multivariate analysis, predictors of poor outcome were increased age [odds ratio (OR) 1.73 for every 10-year increase; 95% CI, 1.35 to 2.21], neutrophilia (OR 1.06 for every 1×109/L increase; 95% CI, 1.02 to 1.11) and high LDH (OR 1.17 for every 100 U/L increase; 95% CI, 1.02 to 1.34). None of the 12 paediatric patients had an adverse event. Conclusion: Advanced age, neutrophilia and high LDH predict poor outcomes in patients with SARS.

Original languageEnglish
Pages (from-to)326-331
Number of pages6
JournalAnnals of the Academy of Medicine Singapore
Issue number5
Publication statusPublished - 1 May 2006
Externally publishedYes


  • Prognosis
  • SARS virus
  • Singapore

Cite this

Leong, H. N., Earnest, A., Lim, H. H., Chin, C. F., Tan, C. S. H., Puhaindran, M. E., Tan, A. C. H., Chen, M. I. C., & Leo, Y. S. (2006). SARS in Singapore - Predictors of disease severity. Annals of the Academy of Medicine Singapore, 35(5), 326-331.