ArticlesClinical presentation, biochemical, and haematological parameters and their association with outcome in patients with Ebola virus disease: an observational cohort study
Introduction
Ebola virus disease is caused by an RNA filovirus, and is characterised by a febrile illness (recorded in 87% of patients with Ebola virus disease), often progressing to diarrhoea (67%), vomiting (66%), and, sometimes, haemorrhage (18%).1 The current outbreak in west Africa is the largest up to now, with more than 27 500 cases (Aug 2, 2015).2 Clinical and public health management is challenging, especially in the worst hit countries of Sierra Leone, Liberia, and Guinea, because of severity of clinical presentation, infection control concerns, poor health-system infrastructure, and high population density.3, 4
There is currently no proven treatment for Ebola virus disease; therefore, management is supportive, including administration of oral and intravenous fluids and electrolytes, management of co-infections, and symptom control.3, 4, 5 Ebola virus disease causes marked biochemical abnormalities, which might be amenable to simple interventions, potentially reducing the high case fatality rate.4, 6, 7, 8, 9, 10, 11, 12 Because of the low-resource setting of outbreaks and risks associated with the collection and processing of laboratory samples, few data exist for these abnormalities, mostly from animal models, small cohorts, or case studies from resource-rich settings.6, 7, 8, 9, 11, 13
Kerry Town Ebola treatment centre, operated by Save the Children, opened on Nov 5, 2014, in Sierra Leone offering supportive care focused on fluid and electrolyte management, in accordance with WHO guidelines.3 This included haematology and biochemistry testing for all admissions from Dec 8, 2014. We aimed to report data for clinical presentation, laboratory abnormalities, and their association with mortality in patients admitted in 1 month. We hoped these data would improve understanding of key variables associated with outcome, inform clinical management algorithms, and provide insight into the pathophysiology of Ebola virus disease.
Section snippets
Study design
We undertook a cohort study of patients consecutively admitted to Kerry Town Ebola treatment centre between Dec 8, 2014, and Jan 9, 2015. During this period only patients with Ebola virus disease confirmed at other isolation or community care centres were admitted. We used a standard case definition as per WHO guidelines.2 All patients were included in the study except for those who were dead on arrival, or those who had no blood results within 24 h of admission. Primary outcome measure was
Results
During the study period, 150 patients were admitted with confirmed Ebola virus disease. Additionally, six patients who did not have Ebola virus disease were referred and four patients died in transit. Absent laboratory samples were the result of no sample being obtained on admission (n=8) and a laboratory isolator fault meaning no samples were processed between Dec 26 and Dec 29 (n=24). Of the 118 included patients, 104 had haematology parameters analysed and 114 had biochemistry analysed. In
Discussion
The natural history of Ebola virus disease is well characterised with a gastrointestinal stage leading to pronounced hypovolaemia, systemic hypoperfusion, and shock in patients who are inadequately fluid-resuscitated.4 The extent of multiorgan dysfunction syndrome, which commonly affects the renal, hepatic, neurological, and coagulation systems, varies from mild dysfunction to irreversible organ failure and death, but the pathogenesis of Ebola virus disease remains poorly understood. The
References (22)
Ebola virus disease in West Africa—the first 9 months of the epidemic and forward projections
N Engl J Med
(2014)WHO Ebola situational report. Aug 5, 2015
(2015)Clinical management of patients with viral haemorrhagic fever: a pocket guide for the front-line health workers
(2014)- et al.
Caring for critically ill patients with ebola virus disease. Perspectives from West Africa
Am J Respir Crit Care Med
(2014) - et al.
Treatment of Ebola virus disease
Intensive Care Med
(2015) - et al.
Blood chemistry measurements and D-dimer levels associated with fatal and nonfatal outcomes in humans infected with Sudan Ebola virus
J Infect Dis
(2007) - et al.
Clinical illness and outcomes in patients with Ebola in Sierra Leone
N Engl J Med
(2014) - et al.
Analysis of human peripheral blood samples from fatal and nonfatal cases of Ebola (Sudan) hemorrhagic fever: cellular responses, virus load, and nitric oxide levels
J Virol
(2004) - et al.
Basic clinical and laboratory features of filoviral hemorrhagic fever
J Infect Dis
(2011) - et al.
Clinical presentation of patients with Ebola virus disease in Conakry, Guinea
N Engl J Med
(2015)
Ebola virus disease in West Africa—clinical manifestations and management
N Engl J Med
Cited by (159)
Infections and Acute Kidney Injury: A Global Perspective
2024, Seminars in NephrologyEbola virus disease: A review for the emergency medicine clinician
2023, American Journal of Emergency MedicineGlobal analysis of gene expression profiles and gout symptoms in goslings infected with goose astrovirus
2023, Veterinary Microbiology