Lancet ID: Clinical presentation, biochemical, and haematological parameters and their association with outcome in patients with Ebola virus disease:

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[h=1]Clinical presentation, biochemical, and haematological parameters and their association with outcome in patients with Ebola virus disease: an observational cohort study[/h] Dr Luke Hunt, MBChB

, Ankur Gupta-Wright, MSc
, Victoria Simms, PhD
, Fayia Tamba, HND
, Victoria Knott, MBChB
, Kongoneh Tamba, HND
, Saidu Heisenberg-Mansaray, HND
, Emmanuel Tamba, HND
, Alpha Sheriff
, Sulaiman Conteh, MBChB
, Tom Smith, MSc
, Shelagh Tobin, BSc
, Tim Brooks, MBChB
, Catherine Houlihan, MSc
, Rachael Cummings, MSc
, Tom Fletcher, MRCP

Published Online: 10 August 2015

DOI: http://dx.doi.org/10.1016/S1473-3099(15)00144-9
[h=2]Summary[/h] [h=3]Background[/h] 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.
[h=3]Methods[/h] 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.
[h=3]Findings[/h] 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.
[h=3]Interpretation[/h] 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.

http://www.thelancet.com/journals/laninf/article/PIIS1473-3099(15)00144-9/abstract

 

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[h=1]New Ebola study published in Lancet Infectious Diseases[/h]

LSTM?s research fellow and lecturer, Dr Tom Fletcher, is senior author on a new paper published today in the journal, Lancet Infectious Diseases, based on an observational cohort study of patients with Ebola virus disease admitted to the Kerry Town Ebola treatment centre in Sierra Leone, during the current outbreak of the disease.



Ebola virus disease (EVD), previously known as Ebola haemorrhagic fever, is a severe, often fatal illness in humans. The virus is zoonotic, in that it is transmitted to people through wild animals, often through contaminated meat, and is spread through human-to-human contact. First recorded in 1976, the current outbreak in West Africa began in March 2014 and is estimated to have claimed the lives of over 11 thousand people to date (WHO).
The study, commissioned by the UK charity Save the Children, was designed to look at the clinical presentation, biochemical, and haematological parameters and their association with EVD. The finding are based on 150 patients who were admitted to the centre between 8 December 2014 and 9 January 2015, and had blood taken for Ebola confirmation and for haematological and biochemical analysis in order to study the association between these and the clinical outcome.
The average age of the patients recruited to the study was 26 years and the overall case fatality was 37%. Most patients were admitted with stage 2 or 3 of the disease and high levels of organ dysfunction and haematological abnormalities. The study found that kidney dysfunction was not restricted to late disease stages and supports the case for monitoring renal function and intravenous fluid treatment in early disease, even when dehydration is a less common clinical finding.
The study was also the first to record data for haematological abnormalities and suggests that mortality was associated with increased haemoglobin concentrations, potentially a marker for intravascular fluid depletion, widely believed to be associated with poor outcomes. The study also advocated that the most important aspects of supportive care was the aggressive management of intravascular volume depletion, the correction of electrolyte abnormalities and prevention of complications as a result of shock.
The authors are keen to promote the provision of routine laboratory support to an Ebola treatment centre. Dr Tom Fletcher said: ?Ours is the largest and most complete study of EVD undertaken to date and as such we have been able to shed light on the organ dysfunction that is previously poorly understood. The provision of laboratory support needs to be standard in these settings to afford us the opportunity for improved understanding of disease pathogenesis and pathophysiology in humans. The knowledge gained along with better supportive care can help inform evidence based protocols to improve outcomes for this outbreak and the next.?
http://www.lstmed.ac.uk/news-events/news/new-ebola-study-published-in-lancet-infectious-diseases