Adam R Aluisio1, Shiromi M Perera2, Derrick Yam3, Stephanie Garbern1, Jillian L Peters4, Logan Abel4, Daniel K Cho5, Stephen B Kennedy6, Moses Massaquoi6, Foday Sahr7, Suzanne Brinkmann2, Lindsey Locks8, Tao Liu3, Adam C Levine1. 1. Department of Emergency Medicine, Brown University Warren Alpert Medical School, Providence, RI, USA. 2. International Medical Corps, Washington, DC, USA. 3. Brown University, School of Public Health, Center for Statistical Sciences, Department of Biostatistics, Providence, RI, USA. 4. Warren Alpert Medical School of Brown University, Providence, RI, USA. 5. Brown University, Providence, RI, USA. 6. Ministry of Health, Monrovia, Liberia. 7. College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone. 8. Department of Health Sciences, Boston University: Sargent College, Boston, MA, USA.
Abstract
BACKGROUND: Micronutrient supplementation is recommended in Ebola virus disease (EVD); however, there are limited data on therapeutic impacts of specific micronutrients. OBJECTIVE: To evaluate the association between vitamin A supplementation and mortality in EVD. METHODS: This retrospective cohort included patients with EVD admitted to 5 International Medical Corps Ebola Treatment Units (ETUs) in 2 countries during 2014-2015. Protocolized treatments with micronutrients were used at all ETUs: however, because of resource constraints, only a subset of patients received vitamin A. Standardized data on demographics, clinical characteristics, malaria status, and Ebola viral loads (cycle threshold values) were collected. The outcome of interest was mortality between cases treated with 200,000 IU of vitamin A on care days 1 and/or 2, and those not. Propensity scores based on the first 48 h of care were derived using covariates of age, ETU duration, malaria status, cycle threshold values, and clinical symptoms. Patients were matched 1:1 using nearest neighbors with replacement. Mortality between cases treated and not treated with vitamin A was compared using generalized estimating equations to calculate RR with associated 95% CI. RESULTS: There were 424 cases analyzed, of which 330 (77.8%) were treated with vitamin A. The mean age was 30.5 y and 40.3% were men. The most common symptoms were diarrhea (85.6%), anorexia (80.7%), and abdominal pain (76.9%). Mortality proportions among cases treated and not treated with vitamin A were 55.0% and 71.9%, respectively. In the propensity-matched analysis, mortality was significantly lower among cases receiving vitamin A (RR = 0.77, 95% CI: 0.59, 0.99; P = 0.041). In a subgroup analysis of patients treated with multivitamins already containing vitamin A, additional vitamin A supplementation did not impact mortality. CONCLUSION: Early vitamin A supplementation was associated with reduced mortality in patients with EVD, and should be further studied and considered for use in future epidemics.
BACKGROUND: Micronutrient supplementation is recommended in Ebola virus disease (EVD); however, there are limited data on therapeutic impacts of specific micronutrients. OBJECTIVE: To evaluate the association between vitamin A supplementation and mortality in EVD. METHODS: This retrospective cohort included patients with EVD admitted to 5 International Medical Corps Ebola Treatment Units (ETUs) in 2 countries during 2014-2015. Protocolized treatments with micronutrients were used at all ETUs: however, because of resource constraints, only a subset of patients received vitamin A. Standardized data on demographics, clinical characteristics, malaria status, and Ebola viral loads (cycle threshold values) were collected. The outcome of interest was mortality between cases treated with 200,000 IU of vitamin A on care days 1 and/or 2, and those not. Propensity scores based on the first 48 h of care were derived using covariates of age, ETU duration, malaria status, cycle threshold values, and clinical symptoms. Patients were matched 1:1 using nearest neighbors with replacement. Mortality between cases treated and not treated with vitamin A was compared using generalized estimating equations to calculate RR with associated 95% CI. RESULTS: There were 424 cases analyzed, of which 330 (77.8%) were treated with vitamin A. The mean age was 30.5 y and 40.3% were men. The most common symptoms were diarrhea (85.6%), anorexia (80.7%), and abdominal pain (76.9%). Mortality proportions among cases treated and not treated with vitamin A were 55.0% and 71.9%, respectively. In the propensity-matched analysis, mortality was significantly lower among cases receiving vitamin A (RR = 0.77, 95% CI: 0.59, 0.99; P = 0.041). In a subgroup analysis of patients treated with multivitamins already containing vitamin A, additional vitamin A supplementation did not impact mortality. CONCLUSION: Early vitamin A supplementation was associated with reduced mortality in patients with EVD, and should be further studied and considered for use in future epidemics.
Authors: M Barry; F A Traoré; F B Sako; D O Kpamy; E I Bah; M Poncin; S Keita; M Cisse; A Touré Journal: Med Mal Infect Date: 2014-10-23 Impact factor: 2.152
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Authors: Adam R Aluisio; Shiromi M Perera; Derrick Yam; Stephanie Garbern; Jillian L Peters; Logan Abel; Daniel K Cho; Dayan Woldemichael; Stephen B Kennedy; Moses Massaquoi; Foday Sahr; Tao Liu; Adam C Levine Journal: Trop Med Int Health Date: 2020-01-22 Impact factor: 2.622
Authors: Philip T James; Zakari Ali; Andrew E Armitage; Ana Bonell; Carla Cerami; Hal Drakesmith; Modou Jobe; Kerry S Jones; Zara Liew; Sophie E Moore; Fernanda Morales-Berstein; Helen M Nabwera; Behzad Nadjm; Sant-Rayn Pasricha; Pauline Scheelbeek; Matt J Silver; Megan R Teh; Andrew M Prentice Journal: J Nutr Date: 2021-07-01 Impact factor: 4.798
Authors: Logan Abel; Shiromi M Perera; Derrick Yam; Stephanie Garbern; Stephen B Kennedy; Moses Massaquoi; Foday Sahr; Dayan Woldemichael; Tao Liu; Adam C Levine; Adam R Aluisio Journal: BMC Infect Dis Date: 2022-01-20 Impact factor: 3.090