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Multicenter Study
. 2018 May:70:51-56.
doi: 10.1016/j.ijid.2018.03.005. Epub 2018 Mar 14.

Early identification of pneumonia patients at increased risk of Middle East respiratory syndrome coronavirus infection in Saudi Arabia

Anwar E Ahmed  1 , Hamdan Al-Jahdali  2 , Abeer N Alshukairi  3 , Mody Alaqeel  4 , Salma S Siddiq  5 , Hanan Alsaab  6 , Ezzeldin A Sakr  7 , Hamed A Alyahya  8 , Munzir M Alandonisi  9 , Alaa T Subedar  10 , Nouf M Aloudah  11 , Salim Baharoon  12 , Majid A Alsalamah  13 , Sameera Al Johani  14 , Mohammed G Alghamdi  15
Affiliations
Multicenter Study

Early identification of pneumonia patients at increased risk of Middle East respiratory syndrome coronavirus infection in Saudi Arabia

Anwar E Ahmed et al. Int J Infect Dis. 2018 May.

Abstract

Background: The rapid and accurate identification of individuals who are at high risk of Middle East respiratory syndrome coronavirus (MERS-CoV) infection remains a major challenge for the medical and scientific communities. The aim of this study was to develop and validate a risk prediction model for the screening of suspected cases of MERS-CoV infection in patients who have developed pneumonia.

Methods: A two-center, retrospective case-control study was performed. A total of 360 patients with confirmed pneumonia who were evaluated for MERS-CoV infection by real-time reverse transcription polymerase chain reaction (rRT-PCR) between September 1, 2012 and June 1, 2016 at King Abdulaziz Medical City in Riyadh and King Fahad General Hospital in Jeddah, were included. According to the rRT-PCR results, 135 patients were positive for MERS-CoV and 225 were negative. Demographic characteristics, clinical presentations, and radiological and laboratory findings were collected for each subject.

Results: A risk prediction model to identify pneumonia patients at increased risk of MERS-CoV was developed. The model included male sex, contact with a sick patient or camel, diabetes, severe illness, low white blood cell (WBC) count, low alanine aminotransferase (ALT), and high aspartate aminotransferase (AST). The model performed well in predicting MERS-CoV infection (area under the receiver operating characteristics curves (AUC) 0.8162), on internal validation (AUC 0.8037), and on a goodness-of-fit test (p=0.592). The risk prediction model, which produced an optimal probability cut-off of 0.33, had a sensitivity of 0.716 and specificity of 0.783.

Conclusions: This study provides a simple, practical, and valid algorithm to identify pneumonia patients at increased risk of MERS-CoV infection. This risk prediction model could be useful for the early identification of patients at the highest risk of MERS-CoV infection. Further validation of the prediction model on a large prospective cohort of representative patients with pneumonia is necessary.

Keywords: Early diagnosis; MERS-CoV case definitions; Pneumonia; Saudi Arabia.

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Figures

Figure 1
Figure 1
The performance of proposed algorithm.
See this image and copyright information in PMC

References

    1. Ahmed A.E., McClish D.K., Schubert C.M. Accuracy and cost comparison in medical testing using sequential testing strategies. Stat Med. 2011:3416–3430. - PubMed
    1. Ahmed A.E., Schubert C.M., McClish D.K. Reducing cost in sequential testing: a limit of indifference approach. Stat Med. 2013:2715–2727. - PubMed
    1. Ahmed A.E., McClish D.K., Schubert C.M. Believe the extreme (BE) strategy at the optimal point: what strategy will it become? Austin Biom Biostat. 2015;2(3):1022.
    1. Ahmed A.E. Diagnostic delays in 537 symptomatic cases of Middle East respiratory syndrome coronavirus infection in Saudi Arabia. Int J Infect Dis. 2017;1(62):47–51. - PMC - PubMed
    1. Ahmed A.E. Estimating survival rates in MERS-CoV patients 14 and 45 days after experiencing symptoms and determining the differences in survival rates by demographic data, disease characteristics and regions: a worldwide study. Epidemiol Infect. 2017:1–7. - PMC - PubMed

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