Association of clinical signs and symptoms of Ebola viral disease with case fatality: a systematic review and meta-analysis.
BACKGROUND
Ebola virus disease (EVD) is a public health emergency of international concern. There is limited laboratory and clinical data available on patients with EVD. This is a meta-analysis to assess the utility of clinical signs, symptoms, and laboratory data in predicting mortality in EVD.


OBJECTIVE
To assess the utility of clinical signs, symptoms, and laboratory data in predicting mortality in EVD.


METHODS
Study selection criterion: EVD articles with more than 35 EVD cases that described the clinical features were included. Data collection and extraction: Articles were searched in Medline, PubMed, Ovid journals, and CDC and WHO official websites.


METHODS
Pooled proportions were calculated using DerSimonian Laird method (random effects model).


RESULTS
Initial search identified 634 reference articles, of which 67 were selected and reviewed. Data were extracted from 10 articles (N=5,792) of EVD which met the inclusion criteria. Bleeding events (64.5% vs. 25.1%), abdominal pain (58.3% vs. 37.5%), vomiting (60.8% vs. 31.7%), diarrhea (69.9% vs. 37.8%), cough (31.6% vs. 22.3%), sore throat (47.7% vs. 19.8%), and conjunctivitis (39.3% vs. 20.3%) were more often present in pooled proportion of fatal cases as compared to EVD survivors.


CONCLUSIONS
Clinical features of EVD that may be associated with higher mortality include bleeding events, vomiting, diarrhea, abdominal pain, cough, sore throat, and conjunctivitis. These patients should be identified promptly, and appropriate management should be instituted immediately.
Division of General Internal Medicine, University of Illinois College of Medicine at Peoria, Peoria, IL, USA; harsha1778@yahoo.co.in.
Harsha
H
Moole
Division of General Internal Medicine, University of Illinois College of Medicine at Peoria, Peoria, IL, USA.
Swetha
S
Chitta
Division of General Internal Medicine, University of Illinois College of Medicine at Peoria, Peoria, IL, USA.
Darlyn
D
Victor
Division of General Internal Medicine, University of Illinois College of Medicine at Peoria, Peoria, IL, USA.
Manasa
M
Kandula
Division of General Internal Medicine, Mamatha Medical College, NTR University of Health Sciences, Vijayawada, India.
Vishnu
V
Moole
Division of General Internal Medicine, University of Illinois College of Medicine at Peoria, Peoria, IL, USA.
Harshavardhan
H
Ghadiam
Division of General Internal Medicine, University of Illinois College of Medicine at Peoria, Peoria, IL, USA.
Anusha
A
Akepati
Division of General Internal Medicine, Georgetown University Hospital, Washington, DC, USA.
Charan
C
Yerasi
Division of General Internal Medicine, Bronx Lebanon Hospital, New York, NY, USA.
Achuta
A
Uppu
Division of General Internal Medicine, Deccan Medical College, NTR University of Health Sciences, Vijayawada, India.
Sowmya
S
Dharmapuri
Division of General Internal Medicine, Pinnamaneni Siddhartha Medical College, NTR University of Medical Sciences, Vijayawada, India.
Raghuveer
R
Boddireddy
Division of General Internal Medicine, University of Illinois College of Medicine at Peoria, Peoria, IL, USA.
Jacqueline
J
Fischer
Division of General Internal Medicine, University of Illinois College of Medicine at Peoria, Peoria, IL, USA.
Teresa
T
Lynch
Ebola viral disease; clinical signs; clinical symptoms; meta-analysis; mortality; systematic review