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Commentary
Acute Renal
Impairment In 2003
SARS-CoV Cases
Recombinomics
Commentary 20:30
September 25, 2012
“This is not SARS, it will not become SARS, and it is not SARS-like,'' he said, pointing out that what sets the new virus apart was that it caused rapid kidney failure.
RESULTS: Among these 536 patients with SARS, 36 (6.7%) developed acute renal impairment occurring at a median duration of 20 days (range 5-48 days)
The mortality rate was significantly higher among patients with SARS and acute renal impairment compared with those with SARS and no renal impairment (91.7% vs. 8.8%) (P < 0.0001).
CONCLUSION: Acute renal impairment is uncommon in SARS but carries a high mortality. The acute renal impairment is likely to be related to multi-organ failure rather than the kidney tropism of the virus. The development of acute renal impairment is an important negative prognostic indicator for survival with SARS.
The above WHO comments (in red) comparing the clinical presentation of the SARS-CoV-like cases in Saudi Arabia / Qatar with SARS-CoV cases in 2003 are directly contradicted by actual data from cases infected with SARS-CoV in 2003 (in blue). The blue quotes are from an abstract of a paper entitled “Acute renal impairment in coronavirus-associated severe acute respiratory syndrome” which notes that about 6% of SARS cases developed acute renal impairment, and had a mortality rate above 90%.
Thus far in 2012 there have only been two confirmed SARS-CoV-like cases. One (60M) was fatal, while the other (47M) is in critical condition and on an ECMO machine. Since these two cases were identified about 3 months apart, and the associated CoV is virtually identical, it is likely that there are a large number of undetected cases, and the two confirmed cases may be among the severe cases which constitute a minority of SARS-CoV-like cases, as was seen in 2003.
Thus, the WHO claim that rapid kidney failure distinguishes the 2012 cases from the 2003 SARS-CoV cases is without scientific basis and is directly contradicted by published data.
Similarly, WHO has noted that the current CoV is not SARS-CoV, while the physician who identified the index case has indicated the sequence from the index case is closely related to bat CoVs, which is also true for the SARS-CoV from 2003.
Therefore, release of sequences from the 2012 cases is critical for independent confirmation of WHO statements on this SARS-CoV-like outbreak, which have a significant credibility problem.
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