Clinical presentation, biochemical, and haematological parameters and their association with outcome in patients with Ebola virus disease: an observational cohort study.
BACKGROUND
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.


METHODS
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.


RESULTS
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.


CONCLUSIONS
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.


BACKGROUND
None.
Save the Children International, London, UK. Electronic address: Luke.hunt@doctors.org.uk.
Luke
L
Hunt
Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK.
Ankur
A
Gupta-Wright
Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK.
Victoria
V
Simms
Ministry of Health and Sanitation, Freetown, Sierra Leone.
Fayia
F
Tamba
Save the Children International, London, UK.
Victoria
V
Knott
Ministry of Health and Sanitation, Freetown, Sierra Leone.
Kongoneh
K
Tamba
Ministry of Health and Sanitation, Freetown, Sierra Leone.
Saidu
S
Heisenberg-Mansaray
Ministry of Health and Sanitation, Freetown, Sierra Leone.
Emmanuel
E
Tamba
Save the Children International, London, UK.
Alpha
A
Sheriff
Save the Children International, London, UK.
Sulaiman
S
Conteh
Save the Children International, London, UK.
Tom
T
Smith
Defence Medical Services, Whittington Barracks, Lichfield, UK.
Shelagh
S
Tobin
Public Health England, Porton Down, Salisbury, UK.
Tim
T
Brooks
Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK.
Catherine
C
Houlihan
Save the Children International, London, UK.
Rachael
R
Cummings
Defence Medical Services, Whittington Barracks, Lichfield, UK; Liverpool School of Tropical Medicine, Liverpool, Merseyside, UK.
Tom
T
Fletcher
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001773:Blood Cells; D001774:Blood Chemical Analysis; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D019142:Hemorrhagic Fever, Ebola / Q000401:mortality / Q000473:pathology* / Q000503:physiopathology*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D009026:Mortality; D012807:Sierra Leone; D016896:Treatment Outcome; D055815:Young Adult