Luke Hunt1, Ankur Gupta-Wright2, Victoria Simms3, Fayia Tamba4, Victoria Knott5, Kongoneh Tamba4, Saidu Heisenberg-Mansaray4, Emmanuel Tamba4, Alpha Sheriff5, Sulaiman Conteh5, Tom Smith5, Shelagh Tobin6, Tim Brooks7, Catherine Houlihan2, Rachael Cummings5, Tom Fletcher8. 1. Save the Children International, London, UK. Electronic address: Luke.hunt@doctors.org.uk. 2. Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK. 3. Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK. 4. Ministry of Health and Sanitation, Freetown, Sierra Leone. 5. Save the Children International, London, UK. 6. Defence Medical Services, Whittington Barracks, Lichfield, UK. 7. Public Health England, Porton Down, Salisbury, UK. 8. Defence Medical Services, Whittington Barracks, Lichfield, UK; Liverpool School of Tropical Medicine, Liverpool, Merseyside, UK.
Abstract
BACKGROUND: Clinical management of Ebola virus disease remains challenging. Routine laboratory analytics are often unavailable in the outbreak setting, and few data exist for the associated haematological and biochemical abnormalities. We aimed to assess laboratory and clinical data from patients with Ebola virus disease to better inform clinical management algorithms, improve understanding of key variables associated with outcome, and provide insight into the pathophysiology of Ebola virus disease. METHODS: We recruited all patients, alive on arrival, with confirmed Ebola virus disease who were admitted to the Kerry Town Ebola treatment centre in Sierra Leone. At admission, all patients had clinical presentation recorded and blood taken for Ebola confirmation using reverse-transcriptase-PCR (RT-PCR) and for haematological and biochemical analysis. We studied the association between these and clinical outcome. The primary outcome was discharge from the Ebola treatment centre. FINDINGS: 150 patients were admitted to the treatment centre between Dec 8, 2014, and Jan 9, 2015. The mean age of patients was 26 years (SD 14·7). Case fatality rate was 37% (55/150). Most patients presented with stage 2 (gastrointestinal involvement, 72/118 [61%]) and stage 3 (severe or complicated, 12/118 [10%]) disease. Acute kidney injury was common (52/104 [50%]), as were abnormal serum potassium (32/97 [33%]), severe hepatitis (54/92 [59%]), and raised C-reactive protein (21/100 [21%]). Haematological abnormalities were common, including raised haematocrit (15/100 [15%]), thrombocytopenia (47/104 [45%]), and granulocytosis (44/104 [42%]). Severe acute kidney injury, low RT-PCR cycle threshold (<20 cycles), and severe hepatitis were independently associated with mortality. INTERPRETATION: Ebola virus disease is associated with a high prevalence of haematological and biochemical abnormalities, even in mild disease and in the absence of gastrointestinal symptoms. Clinical care that targets hypovolaemia, electrolyte disturbance, and acute kidney injury is likely to reduce historically high case fatality rates. FUNDING: None.
BACKGROUND: Clinical management of Ebola virus disease remains challenging. Routine laboratory analytics are often unavailable in the outbreak setting, and few data exist for the associated haematological and biochemical abnormalities. We aimed to assess laboratory and clinical data from patients with Ebola virus disease to better inform clinical management algorithms, improve understanding of key variables associated with outcome, and provide insight into the pathophysiology of Ebola virus disease. METHODS: We recruited all patients, alive on arrival, with confirmed Ebola virus disease who were admitted to the Kerry Town Ebola treatment centre in Sierra Leone. At admission, all patients had clinical presentation recorded and blood taken for Ebola confirmation using reverse-transcriptase-PCR (RT-PCR) and for haematological and biochemical analysis. We studied the association between these and clinical outcome. The primary outcome was discharge from the Ebola treatment centre. FINDINGS: 150 patients were admitted to the treatment centre between Dec 8, 2014, and Jan 9, 2015. The mean age of patients was 26 years (SD 14·7). Case fatality rate was 37% (55/150). Most patients presented with stage 2 (gastrointestinal involvement, 72/118 [61%]) and stage 3 (severe or complicated, 12/118 [10%]) disease. Acute kidney injury was common (52/104 [50%]), as were abnormal serum potassium (32/97 [33%]), severe hepatitis (54/92 [59%]), and raised C-reactive protein (21/100 [21%]). Haematological abnormalities were common, including raised haematocrit (15/100 [15%]), thrombocytopenia (47/104 [45%]), and granulocytosis (44/104 [42%]). Severe acute kidney injury, low RT-PCR cycle threshold (<20 cycles), and severe hepatitis were independently associated with mortality. INTERPRETATION:Ebola virus disease is associated with a high prevalence of haematological and biochemical abnormalities, even in mild disease and in the absence of gastrointestinal symptoms. Clinical care that targets hypovolaemia, electrolyte disturbance, and acute kidney injury is likely to reduce historically high case fatality rates. FUNDING: None.
Authors: Jerry F Brown; Kathleen Rowe; Peter Zacharias; James van Hasselt; John M Dye; David A Wohl; William A Fischer; Coleen K Cunningham; Nathan M Thielman; David L Hoover Journal: J Clin Apher Date: 2016-07-08 Impact factor: 2.821
Authors: Adam R Aluisio; Shiromi M Perera; Derrick Yam; Stephanie Garbern; Jillian L Peters; Logan Abel; Daniel K Cho; Stephen B Kennedy; Moses Massaquoi; Foday Sahr; Suzanne Brinkmann; Lindsey Locks; Tao Liu; Adam C Levine Journal: J Nutr Date: 2019-10-01 Impact factor: 4.798
Authors: Richard T Davey; Lori Dodd; Michael A Proschan; James Neaton; Jacquie Neuhaus Nordwall; Joseph S Koopmeiners; John Beigel; John Tierney; H Clifford Lane; Anthony S Fauci; Moses B F Massaquoi; Foday Sahr; Denis Malvy Journal: N Engl J Med Date: 2016-10-13 Impact factor: 91.245
Authors: Adam R Aluisio; Derrick Yam; Jillian L Peters; Daniel K Cho; Shiromi M Perera; Stephen B Kennedy; Moses Massaquoi; Foday Sahr; Michael A Smit; Tao Liu; Adam C Levine Journal: Clin Infect Dis Date: 2020-03-03 Impact factor: 9.079
Authors: M L Boisen; J N Hartnett; A Goba; M A Vandi; D S Grant; J S Schieffelin; R F Garry; L M Branco Journal: Annu Rev Virol Date: 2016-08-15 Impact factor: 10.431
Authors: Matthew L Boisen; Robert W Cross; Jessica N Hartnett; Augustine Goba; Mambu Momoh; Mohamed Fullah; Michael Gbakie; Sidiki Safa; Mbalu Fonnie; Francis Baimba; Veronica J Koroma; Joan B Geisbert; Stephanie McCormick; Diana K S Nelson; Molly M Millett; Darin Oottamasathien; Abby B Jones; Ha Pham; Bethany L Brown; Jeffrey G Shaffer; John S Schieffelin; Brima Kargbo; Momoh Gbetuwa; Sahr M Gevao; Russell B Wilson; Kelly R Pitts; Thomas W Geisbert; Luis M Branco; Sheik H Khan; Donald S Grant; Robert F Garry Journal: J Infect Dis Date: 2016-08-11 Impact factor: 5.226
Authors: Elizabeth R Wonderlich; Amy L Caroline; Cynthia M McMillen; Aaron W Walters; Douglas S Reed; Simon M Barratt-Boyes; Amy L Hartman Journal: J Virol Date: 2018-01-17 Impact factor: 5.103