The diagnosis, prognosis and treatment of the severe acute respiratory syndrome (SARS): A retrospective cohort study of the Toronto SARS outbreak
Bibliographic record
Abstract
Background. During the global severe acute respiratory syndrome (SARS) outbreak, patients were treated with high dose ribavirin although its safety and efficacy were unknown. We conducted a retrospective cohort study of the completed Toronto SARS outbreak to evaluate the efficacy and safety of ribavirin in the treatment of SARS. Methods. The study population included all adult patients hospitalized with suspected SARS. Cases were classified as confirmed, excluded or indeterminate using microbiological methods. The presentation of confirmed and excluded SARS patients were compared to identify diagnostically useful findings. A prognostic rule predictive of mechanical ventilation and/or death was derived using multivariable regression and externally validated. A logistic model predictive of treatment status was used to assign a propensity score to each patient. Patients were stratified into five groups based on their propensity score. Post-stratification covariate balance was assessed using standardized differences. The treatment effect was estimated within quintiles and then averaged across quintiles. The incidence of adverse events were compared in treated and untreated patients. Results. Direct contact with a SARS case, fever, lymphopenia or thrombocytopenia were more common in confirmed cases, while rhinorrhea, sore throat, productive cough and an elevated absolute neutrophil count were more common in excluded cases. Age, pulmonary infiltrates and hypoxemia were independent predictors of mechanical ventilation and/or death. Our prognostic rule had an area under the receiver operating characteristic curve of 0.88, which fell to 0.77 on external validation. We were unable to obtain covariate balance using propensity score stratification, suggesting that residual confounding was present in our estimates of treatment effect. Progressive anemia, bradycardia, hypomagnesemia and hypocalcemia were associated with the use of ribavirin. Conclusions. Clinical and epidemiological findings may be useful in the diagnosis of SARS. Our prognostic rule identifies patients at risk of respiratory failure due to SARS and could be used to assist in making triage and treatment decisions. Ribavirin efficacy could not be established and ribavirin use was associated with frequent adverse events. Our results suggest that ribavirin should not be used in the treatment of future SARS cases except in the context of a randomized controlled trial.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.001 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".