Jean Marie Cournac1, Ludovic Karkowski2, Julien Bordes3, Marc Aletti1, Sandrine Duron4, Frédéric Janvier3, Vincent Foissaud1, Hélène Savini5, Thierry de Greslan6, Claire Rousseau7, Magali Billhot6, Nicolas Gagnon2, Christine Mac Nab1, Philippe Dubrous8, Sophie Moroge5, Helene Broto9, Jean Cotte3, Nancy Maugey10, Pierre-Yves Cordier5, Emmanuel Sagui5, Audrey Merens11, Christophe Rapp11, Benoit Quentin10, Hervé Granier7, Thierry Carmoi6, Gilles Cellarier3. 1. French Military Ebola Virus Disease Treatment Centre, Conakry, Guinea Percy Military Teaching Hospital, Clamart. 2. French Military Ebola Virus Disease Treatment Centre, Conakry, Guinea Legouest Military Teaching Hospital, Metz. 3. French Military Ebola Virus Disease Treatment Centre, Conakry, Guinea Sainte Anne Military Teaching Hospital, Toulon. 4. French Military Ebola Virus Disease Treatment Centre, Conakry, Guinea French Military Center for Epidemiology and Public Health. 5. French Military Ebola Virus Disease Treatment Centre, Conakry, Guinea Laveran Military Teaching Hospital, Marseille. 6. French Military Ebola Virus Disease Treatment Centre, Conakry, Guinea Val De Grâce Military Teaching Hospital. 7. French Military Ebola Virus Disease Treatment Centre, Conakry, Guinea Clermont Tonnerre Military Teaching Hospital, Brest. 8. French Military Ebola Virus Disease Treatment Centre, Conakry, Guinea Robert Picqué Military Teaching Hospital, Bordeaux. 9. French Military Ebola Virus Disease Treatment Centre, Conakry, Guinea French Military Center for Health Supplies, Orléans. 10. French Military Ebola Virus Disease Treatment Centre, Conakry, Guinea French Military Health Service Surgeon General Office, Paris. 11. French Military Ebola Virus Disease Treatment Centre, Conakry, Guinea Bégin Military Teaching Hospital, Saint-Mandé, France.
Abstract
BACKGROUND: The pathogenesis of Ebola virus disease (EVD) remains unclear. The sporadic nature of Ebola outbreaks and their occurrence in resource-limited settings have precluded the acquisition of extensive clinical and laboratory data. Rhabdomyolysis during EVD has been suggested to occur in previous studies showing increased aspartate aminotransferase-alanine aminotransferase ratios, but, to date, has not been confirmed with creatine kinase (CK) assays. METHODS: We performed an observational study of 38 patients admitted to an Ebola treatment center from January to April 2015. CK values from patients with confirmed EVD were compared with those in patients without confirmed EVD. A panel of other analyses were also performed. In patients with EVD, characteristics were compared between survivors and nonsurvivors. RESULTS: High levels of CK were more frequent in patients with EVD than in those without (P = .002), and rhabdomyolysis was more frequent (59% vs 19%, respectively; P = .03). CK levels >5000 U/L were observed in 36% of patients with EVD. Also in patients with EVD, fatal outcome was significantly associated with higher creatinine and bilirubin levels, international normalized ratio, and viral load. CONCLUSIONS: Rhabdomyolysis is a frequent disorder in EVD and seems to be more common than in other viral infections. It may contribute to the renal failure observed in nonsurviving patients. More studies are needed to determine the impact of rhabdomyolysis on EVD outcome.
BACKGROUND: The pathogenesis of Ebola virus disease (EVD) remains unclear. The sporadic nature of Ebola outbreaks and their occurrence in resource-limited settings have precluded the acquisition of extensive clinical and laboratory data. Rhabdomyolysis during EVD has been suggested to occur in previous studies showing increased aspartate aminotransferase-alanine aminotransferase ratios, but, to date, has not been confirmed with creatine kinase (CK) assays. METHODS: We performed an observational study of 38 patients admitted to an Ebola treatment center from January to April 2015. CK values from patients with confirmed EVD were compared with those in patients without confirmed EVD. A panel of other analyses were also performed. In patients with EVD, characteristics were compared between survivors and nonsurvivors. RESULTS: High levels of CK were more frequent in patients with EVD than in those without (P = .002), and rhabdomyolysis was more frequent (59% vs 19%, respectively; P = .03). CK levels >5000 U/L were observed in 36% of patients with EVD. Also in patients with EVD, fatal outcome was significantly associated with higher creatinine and bilirubin levels, international normalized ratio, and viral load. CONCLUSIONS:Rhabdomyolysis is a frequent disorder in EVD and seems to be more common than in other viral infections. It may contribute to the renal failure observed in nonsurviving patients. More studies are needed to determine the impact of rhabdomyolysis on EVD outcome.
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