1921
Volume 98, Issue 4
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645

Abstract

Abstract.

Although the high case fatality rate (CFR) associated with Ebola virus disease (EVD) is well documented, there are limited data on the actual modes of death. We conducted a retrospective, observational cohort study among patients with laboratory-confirmed EVD. The patients were all seen at the Eternal Love Winning Africa Ebola Treatment Unit in Monrovia, Liberia, from June to August 2014. Our primary objective was to describe the modes of death of our patients and to determine predictors of mortality. Data were available for 53 patients with laboratory-confirmed EVD, with a median age of 35 years. The most frequent presenting symptoms were weakness (91%), fever (81%), and diarrhea (78%). Visible hemorrhage was noted in 25% of the cases. The CFR was 79%. Odds of death were higher in patients with diarrhea (odds ratio = 26.1, < 0.01). All patients with hemorrhagic signs died ( < 0.01). Among the 18 fatal cases for which clinical information was available, three distinct modes of death were observed: sudden death after a moderate disease process (44%), profuse hemorrhage (33%), and encephalopathy (22%). We found that these modes of death varied by age ( = 0.04), maximum temperature ( = 0.43), heart rate on admission ( = 0.04), time to death from symptom onset ( = 0.13), and duration of hospitalization ( = 0.04). Although further study is required, our findings provide a foundation for developing treatment strategies that factor in patients with specific disease phenotypes (which often require the use of aggressive hydration). These findings provide insights into underlying pathogenic mechanisms resulting in severe EVD and suggest direction for future research and development of effective treatment options.

[open-access] This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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2018-04-04
2018-11-13
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References

  1. Kortepeter MG, Bausch DG, Bray M, , 2011. Basic clinical and laboratory features of filoviral hemorrhagic fever. J Infect Dis 204 (Suppl 3): S810S816.
  2. Faye O, 2015. Use of viremia to evaluate the baseline case fatality ratio of Ebola virus disease and inform treatment studies: a retrospective cohort study. PLoS Med 12: e1001908.
  3. Bah EI, 2015. Clinical presentation of patients with Ebola virus disease in Conakry, Guinea. N Engl J Med 372: 4047.
  4. Barry M, 2015. Clinical predictors of mortality in patients with Ebola virus disease. Clin Infect Dis 60: 18211824.
  5. Hunt L, 2015. Clinical presentation, biochemical, and haematological parameters and their association with outcome in patients with Ebola virus disease: an observational cohort study. Lancet Infect Dis 15: 12921299.
  6. Leroy EM, Baize S, Lu CY, McCormick JB, Georges AJ, Georges-Courbot MC, Lansoud-Soukate J, Fisher-Hoch SP, , 2000. Diagnosis of Ebola haemorrhagic fever by RT-PCR in an epidemic setting. J Med Virol 60: 463467.
  7. Blackley DJ, 2016. Reduced evolutionary rate in reemerged Ebola virus transmission chains. Sci Adv 2: e1600378.
  8. Diallo B, 2016. Resurgence of Ebola virus disease in Guinea linked to a survivor with virus persistence in seminal fluid for more than 500 days. Clin Infect Dis 63: 13531356.
  9. Srikiatkhachorn A, 2007. Natural history of plasma leakage in dengue hemorrhagic fever: a serial ultrasonographic study. Pediatr Infect Dis J 26: 283290; discussion 291–292.
  10. Guilarde AO, Turchi MD, Siqueira JB, Jr Feres VC, Rocha B, Levi JE, Souza VA, Boas LS, Pannuti CS, Martelli CM, , 2008. Dengue and dengue hemorrhagic fever among adults: clinical outcomes related to viremia, serotypes, and antibody response. J Infect Dis 197: 817824.
  11. Srikiatkhachorn A, , 2009. Plasma leakage in dengue haemorrhagic fever. Thromb Haemost 102: 10421049.
  12. Paessler S, Walker DH, , 2013. Pathogenesis of the viral hemorrhagic fevers. Annu Rev Pathol 8: 411440.
  13. Fowler RA, 2014. Caring for critically ill patients with Ebola virus disease: perspectives from west Africa. Am J Respir Crit Care Med 190: 733737.
  14. Uyeki TM, 2016. Working Group of the U.S.–European Clinical Network on Clinical Management of Ebola Virus Disease Patients in the U.S. and Europe. 2016. Clinical management of Ebola virus disease in the United States and Europe. N Engl J Med 374: 636646.
  15. Agua-Agum J, WHO Ebola Response Team, 2015. Ebola virus disease among children in west Africa. N Engl J Med 372: 12741277.
  16. Qin E, 2015. Clinical features of patients with Ebola virus disease in Sierra Leone. Clin Infect Dis 61: 491495.
  17. MacNeil A, 2010. Proportion of deaths and clinical features in Bundibugyo Ebola virus infection, Uganda. Emerg Infect Dis 16: 19691972.
  18. Okware SI, Omaswa FG, Zaramba S, Opio A, Lutwama JJ, Kamugisha J, Rwaguma EB, Kagwa P, Lamunu M, , 2002. An outbreak of Ebola in Uganda. Trop Med Int Health 7: 10681075.
  19. Bwaka MA, 1999. Ebola hemorrhagic fever in Kikwit, Democratic Republic of the Congo: clinical observations in 103 patients. J Infect Dis 179 (Suppl 1): S1S7.
  20. Diehl WE, 2016. Ebola virus glycoprotein with increased infectivity dominated the 2013–2016 epidemic. Cell 167: 10881098.e6.
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  • Received : 06 Feb 2017
  • Accepted : 17 Nov 2017

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