Public Health Service study of Reye's syndrome and medications. Report of the main study
E. S. Hurwitz, M. J. Barrett, D. Bregman, W. J. Gunn, P. Pinsky, L. B. Schonberger, J. S. Drage, R. A. Kaslow, D. B. Burlington, G. V. Quinnan and al. et
Between January 1985 and May 1986, following completion of a pilot study, a
main study concerning the possible association between Reye's syndrome and
salicylates was conducted. Twenty-seven patients with stage II or deeper
Reye's syndrome whose diagnoses were confirmed by an expert panel and who
had appropriate antecedent illnesses (chickenpox, respiratory illness, or
gastrointestinal illness) prior to the onset of Reye's syndrome were
compared with 140 controls matched for age, race (black or not black), and
type and timing of onset of antecedent illness. Controls were selected from
the same hospital, emergency room, or school as case-patients or were
identified by random-digit telephone dialing. As in the pilot study, a
strong statistical association with ingestion of salicylates during the
antecedent illness and prior to the onset of Reye's syndrome was observed
(odds ratio, 40; lower 95% confidence limit, 5.8). Analysis of the
independent risk of aspirin and nonaspirin salicylates revealed a
significant association with aspirin (odds ratio, 26; lower 95% confidence
limit, 6.4); the independent risk of nonaspirin salicylates could not be
assessed because only two cases were not exposed to aspirin. Assessment of
epidemiologic issues of concern, including case-control differences in the
severity of the antecedent illness, did not explain the high odds ratios
that were observed. The high percentage of patients with Reye's syndrome
exposed to salicylates (greater than or equal to 90%) in this and prior
studies suggests that, though the reported incidence of Reye's syndrome has
declined in recent years, concomitant with a decline in salicylate use
among children, a majority of Reye's syndrome cases may be attributable to
salicylate use.
