Clinical Predictors of Mortality in Patients With Ebola Virus Disease

Barry, M.; Touré, Abdoulaye; Traore, Fodé Amara; Sako, Fodé-Bangaly; Sylla, D.; Kpamy, DO; Bah, Elhadj Ibrahima; Bangoura, M.; Poncin, Marc; Кейта, Сакоба; Tounkara, Thierno; Cissé, Mohamed; Vanhems, Philippe

doi:10.1093/cid/civ202

Cited by 38 publications

(23 citation statements)

References 14 publications

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“…2-5 All 5 patients who died were 42 years of age or older; in various studies, age older than 40 years or older than 45 years has been identified as a risk factor in West Africa. 2,21,22 The percentage of patients who died could have been as high as 41% (11 of 27 patients), with up to six additional deaths, if advanced organ support had been unavailable for 2 survivors who received noninvasive ventilation, 2 survivors who received invasive mechanical ventilation, and 2 survivors who received both invasive mechanical ventilation and continuous renal-replacement therapy. A key feature of the clinical care of patients with EVD who were treated in Europe and the United States was the availability of laboratory testing to closely monitor electrolyte levels and hematologic status.…”

Section: Discussionmentioning

confidence: 99%

“…21 Difficulty breathing at admission was associated with a fatal outcome among patients with EVD in Guinea. 22 Overall, 9 of the patients with EVD (33%) who were cared for in the United States or Europe received noninvasive ventilation or invasive mechanical ventilation for respiratory failure. The 2 patients with EVD who received noninvasive ventilation alone survived; however, of the 7 patients who received invasive mechanical ventilation, the 3 patients who also had renal failure that required continuous renal-replacement therapy died.…”

Section: Discussionmentioning

confidence: 99%

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Clinical Management of Ebola Virus Disease in the United States and Europe

Uyeki¹,

Mehta

Davey³

et al. 2016

N Engl J Med

328

288

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Background Available data on the characteristics of patients with Ebola virus disease (EVD) and clinical management of EVD in settings outside West Africa, as well as the complications observed in those patients, are limited. Methods We reviewed available clinical, laboratory, and virologic data from all patients with laboratory-confirmed Ebola virus infection who received care in U.S. and European hospitals from August 2014 through December 2015. Results A total of 27 patients (median age, 36 years [range, 25 to 75]) with EVD received care; 19 patients (70%) were male, 9 of 26 patients (35%) had coexisting conditions, and 22 (81%) were health care personnel. Of the 27 patients, 24 (89%) were medically evacuated from West Africa or were exposed to and infected with Ebola virus in West Africa and had onset of illness and laboratory confirmation of Ebola virus infection in Europe or the United States, and 3 (11%) acquired EVD in the United States or Europe. At the onset of illness, the most common signs and symptoms were fatigue (20 patients [80%]) and fever or feverishness (17 patients [68%]). During the clinical course, the predominant findings included diarrhea, hypoalbuminemia, hyponatremia, hypokalemia, hypocalcemia, and hypomagnesemia; 14 patients (52%) had hypoxemia, and 9 (33%) had oliguria, of whom 5 had anuria. Aminotransferase levels peaked at a median of 9 days after the onset of illness. Nearly all the patients received intravenous fluids and electrolyte supplementation; 9 (33%) received noninvasive or invasive mechanical ventilation; 5 (19%) received continuous renal-replacement therapy; 22 (81%) received empirical antibiotics; and 23 (85%) received investigational therapies (19 [70%] received at least two experimental interventions). Ebola viral RNA levels in blood peaked at a median of 7 days after the onset of illness, and the median time from the onset of symptoms to clearance of viremia was 17.5 days. A total of 5 patients died, including 3 who had respiratory and renal failure, for a mortality of 18.5%. Conclusions Among the patients with EVD who were cared for in the United States or Europe, close monitoring and aggressive supportive care that included intravenous f luid hydration, correction of electrolyte abnormalities, nutritional support, and critical care management for respiratory and renal failure were needed; 81.5% of these patients who received this care survived.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Clinical Management of Ebola Virus Disease in the United States and Europe

Uyeki¹,

Mehta

Davey³

et al. 2016

N Engl J Med

328

288

View full text Add to dashboard Cite

show abstract

“…The recent epidemic of Ebola Virus in West Africa has highlighted this difficulty [3,4]. The lack of mechanism for the management of hemorrhagic diseases could explain the high lethality associated to this epidemic.…”

Section: Introductionmentioning

confidence: 99%

“…The lack of mechanism for the management of hemorrhagic diseases could explain the high lethality associated to this epidemic. Indeed, the presence of hemorrhage is considered as a pejorative prognostic factor in a patient with Ebola Virus disease [4].…”

Section: Introductionmentioning

confidence: 99%

Determining Concentrations of Factors VIII, IX and Fibrinogen in Fresh Frozen Plasma: An Alternative to Improve Treatment of Hemorrhagic Diseases in a Developing Country

Diallo¹

2017

HIJ

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Fresh frozen plasma (FFP) remains the only treatment of bleeding events in some developing countries. But access to this blood derived-product could be difficult. Determined the concentrations of coagulation factors VIII, IX and fibrinogen used in Mali. We have determined prospectively the concentrations of these factors from October 2015 to Conclusion:Concentrations of coagulation factors in the FFP bags produce by NBTC are 1.6 fold lower for factor VIII, and 2.3 fold for factor IX than in other countries. We suggest that the production and distribution of cryoprecipitate could be improved for the effective management of bleeding events in resource-limited countries with no access to specific concentrate coagulation factor.

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“…As of September 16, 2015, the World Health Organization reported 28,220 confirmed, probable, and suspected EVD cases and 11,291 deaths in Guinea, Liberia, and Sierra Leone4. EVD is an infectious disease characterized by high fatality and rapid progress to an outcome of death or recovery, with a fatality rate of 50–90%567. For the ongoing outbreak, the fatality rate for confirmed cases (15,199) is 74.3%.…”

mentioning

confidence: 99%

Development and Evaluation of a Rapid and Sensitive EBOV-RPA Test for Rapid Diagnosis of Ebola Virus Disease

Yang

Yuan

Wang

et al. 2016

Sci Rep

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Confirming Ebola virus disease (EVD), a deadly infectious disease, requires real-time RT-PCR, which takes up to a few hours to yield results. Therefore, a rapid diagnostic assay is imperative for EVD diagnosis. A rapid nucleic acid test based on recombinase polymerase amplification (EBOV-RPA) was developed to specifically detect the 2014 outbreak strains. The EBOV-RPA assay was evaluated by testing samples from suspected EVD patients in parallel with RT-PCR. An EBOV-RPA, which could be completed in 20 min, was successfully developed. Of 271 patients who tested positive for Ebola virus by RT-PCR, 264 (sensitivity: 97%, 95% CI: 95.5–99.3%) were positive by EBOV-RPA; 101 of 104 patients (specificity: 97%, 95% CI: 93.9–100%) who tested negative by RT-PCR were also negative by EBOV-RPA. The sensitivity values for samples with a Ct value of <34, which accounted for 95.59% of the samples, was 100%. Discordant samples positive by RT-PCR but negative by EBOV-RPA had significantly high Ct values. Results of external quality assessment samples with EBOV-RPA were 100%, consistent with those of RT-PCR. The EBOV-RPA assay showed 97% sensitivity and 97% specificity for all EVD samples tested, making it a rapid and sensitive test for EVD diagnosis.

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Clinical Predictors of Mortality in Patients With Ebola Virus Disease

Cited by 38 publications

References 14 publications

Clinical Management of Ebola Virus Disease in the United States and Europe

Clinical Management of Ebola Virus Disease in the United States and Europe

Determining Concentrations of Factors VIII, IX and Fibrinogen in Fresh Frozen Plasma: An Alternative to Improve Treatment of Hemorrhagic Diseases in a Developing Country

Development and Evaluation of a Rapid and Sensitive EBOV-RPA Test for Rapid Diagnosis of Ebola Virus Disease

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