Marie Jaspard1,2, Sabue Mulangu3, Sylvain Juchet1,2, Beatrice Serra1,2, Ibrahim Dicko1, Hans-Joeg Lang1, Baweye Mayoum Baka1, Gaston Musemakweli Komanda4, Jeremie Muhindo Katsavara4, Patricia Kabuni5, Fabrice Mbika Mambu3, Margaux Isnard6, Christophe Vanhecke7, Alexia Letord8, Ibrahima Dieye9, Oscar Patterson-Lomba9, Olivier Tshiani Mbaya3, Fiston Isekusu5, Donatien Mangala5, Jean Luc Biampata3, Richard Kitenge10, Moumouni Kinda1, Xavier Anglaret2, Jean Jacques Muyembe3, Richard Kojan1, Khaled Ezzedine2,11, Denis Malvy2,12. 1. Alliance for International Medical Action (ALIMA), Dakar, Senegal. 2. University of Bordeaux, National Institute for Health and Medical Research (Inserm), Research Institute for Sustainable Development (IRD), Bordeaux Population Health Center, UMR 1219, Bordeaux, France. 3. National Biomedical Research Institute (INRB), Kinshasa, Democratic Republic of the Congo. 4. Beni General Hospital, North Kivu province, Democratic Republic of the Congo. 5. Kinshasa University Hospital, Democratic Republic of the Congo. 6. Intensive Care Unit, Savoie Hospital, France. 7. Internal Medicine Department, West Réunion Hospital, Réunion, France. 8. Surgical Intensive Care Unit, Henri Mondor University Hospital, Créteil, France. 9. Analysis Group Inc., Boston, MA 02199, USA. 10. Ministry of Health, National Emergency and Humanitarian Action Program, Democratic Republic of the Congo. 11. Department of Dermatology, AP-HP, Henri Mondor University Hospital, Créteil, France and Université Paris Est (UPEC), EpiDermE research unit, Paris, France. 12. Department of Infectious Diseases and Tropical Medicine, Tropical Medicine and Clinical International Health Unit, Hôpital Pellegrin Bordeaux University Hospital, Bordeaux, France.
Abstract
Background: As mortality remains high for patients with Ebola virus disease (EVD) despite new treatment options, the ability to level up the provided supportive care and to predict the risk of death is of major importance. This analysis of the EVISTA cohort aims to describe advanced supportive care provided to EVD patients in the Democratic Republic of the Congo (DRC) and to develop a simple risk score for predicting in-hospital death, called PREDS. Methods: In this prospective cohort (NCT04815175), patients were recruited during the 10th EVD outbreak in the DRC across three Ebola Treatment Centers (ETCs). Demographic, clinical, biological, virological and treatment data were collected. We evaluated factors known to affect the risk of in-hospital death and applied univariate and multivariate Cox proportional-hazards analyses to derive the risk score in a training dataset. We validated the score in an internal-validation dataset, applying C-statistics as a measure of discrimination. Findings: Between August 1st 2018 and December 31th 2019, 711 patients were enrolled in the study. Regarding supportive care, patients received vasopressive drug (n = 111), blood transfusion (n = 101), oxygen therapy (n = 250) and cardio-pulmonary ultrasound (n = 15). Overall, 323 (45%) patients died before day 28. Six independent prognostic factors were identified (ALT, creatinine, modified NEWS2 score, viral load, age and symptom duration). The final score range from 0 to 13 points, with a good concordance (C = 86.24%) and calibration with the Hosmer-Lemeshow test (p = 0.12). Interpretation: The implementation of advanced supportive care is possible for EVD patients in emergency settings. PREDS is a simple, accurate tool that could help in orienting early advanced care for at-risk patients after external validation. Funding: This study was funded by ALIMA.
Background: As mortality remains high for patients with Ebola virus disease (EVD) despite new treatment options, the ability to level up the provided supportive care and to predict the risk of death is of major importance. This analysis of the EVISTA cohort aims to describe advanced supportive care provided to EVD patients in the Democratic Republic of the Congo (DRC) and to develop a simple risk score for predicting in-hospital death, called PREDS. Methods: In this prospective cohort (NCT04815175), patients were recruited during the 10th EVD outbreak in the DRC across three Ebola Treatment Centers (ETCs). Demographic, clinical, biological, virological and treatment data were collected. We evaluated factors known to affect the risk of in-hospital death and applied univariate and multivariate Cox proportional-hazards analyses to derive the risk score in a training dataset. We validated the score in an internal-validation dataset, applying C-statistics as a measure of discrimination. Findings: Between August 1st 2018 and December 31th 2019, 711 patients were enrolled in the study. Regarding supportive care, patients received vasopressive drug (n = 111), blood transfusion (n = 101), oxygen therapy (n = 250) and cardio-pulmonary ultrasound (n = 15). Overall, 323 (45%) patients died before day 28. Six independent prognostic factors were identified (ALT, creatinine, modified NEWS2 score, viral load, age and symptom duration). The final score range from 0 to 13 points, with a good concordance (C = 86.24%) and calibration with the Hosmer-Lemeshow test (p = 0.12). Interpretation: The implementation of advanced supportive care is possible for EVD patients in emergency settings. PREDS is a simple, accurate tool that could help in orienting early advanced care for at-risk patients after external validation. Funding: This study was funded by ALIMA.
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