Surviving Ebola: A historical cohort study of Ebola mortality and survival in Sierra Leone 2014-2015

Abstract

BackgroundWhile a number of predictors for Ebola mortality have been identified, less is known about post-viral symptoms. The identification of acute-illness predictors for post-viral symptoms could allow the selection of patients for more active follow up in the future, and those in whom early interventions may be beneficial in the long term. Studying predictors of both mortality and post-viral symptoms within a single cohort of patients could also further our understanding of the pathophysiology of survivor sequelae.Methods/Principal findingsWe performed a historical cohort study using data collected as part of routine clinical care from an Ebola Treatment Centre (ETC) in Kerry Town, Sierra Leone, in order to identify predictors of mortality and of post-viral symptoms. Variables included as potential predictors were sex, age, date of admission, first recorded viral load at the ETC and symptoms (recorded upon presentation at the ETC). Multivariable logistic regression was used to identify predictors. Of 263 Ebola-confirmed patients admitted between November 2014 and March 2015, 151 (57%) survived to ETC discharge. Viral load was the strongest predictor of mortality (adjusted OR comparing high with low viral load: 84.97, 95% CI 30.87–345.94). We did not find evidence that a high viral load predicted post-viral symptoms (ocular: 1.17, 95% CI 0.35–3.97; musculoskeletal: 1.07, 95% CI 0.28–4.08). Ocular post-viral symptoms were more common in females (2.31, 95% CI 0.98–5.43) and in those who had experienced hiccups during the acute phase (4.73, 95% CI 0.90–24.73).Conclusions/SignificanceThese findings may add epidemiological support to the hypothesis that post-viral symptoms have an immune-mediated aspect and may not only be a consequence of high viral load and disease severity.

A Review of Hearing Loss Associated with Zika, Ebola, and Lassa Fever

“…Of the 3,385 individuals studied, 223 (6.6%) were found to have some degree of HL using audiometric evaluation and survey instruments. 19,[36][37][38][39][40][41][42][43][44][45][46][47][48][49][50][51][52][53][54][55] Only one of 21 articles used audiometry to objectively measure HL. This study, by Rowe et al, 19 recruited convalescent Ebola survivors and household contacts following the conclusion of the 1995 Ebola outbreak in Kikwit, DRC.…”

“…The remainder of the articles that described HL as sequelae of Ebola relied on questionnaires or self-report of symptoms. [36][37][38][39][40][41][42][43][44][45][46]50,[52][53][54] The proportion of individuals reporting HL in these articles varied widely, from 0% to 22%. In these studies relying on self-report, HL typically arose late in the course of the disease and persisted throughout recovery.…”

The prevalence of Post-Ebola Syndrome hearing loss, Sierra Leone

“…Little is known regarding hearing loss in Post-EVD Syndrome. A literature review conducted in 2018 found that reports of hearing impairment in EVD survivors varied from 0% to as high as 66% [ 32 , 33 , 39 – 41 ]. However, only one of the studies included in this review included any objective measurement to assess for the presence of this symptom, which may leave many cases of hearing loss undetected [ 28 ].…”

Virus kinetics and biochemical derangements among children with Ebolavirus disease

“…Adult studies have reported that increased VL, AST, ALT, CK, bilirubin, creatinine, urea, INR, and PTT were associated with mortality. 17 , 18 , 20 , 27 …”