title: Development of a Prediction Model for Ebola Virus Disease: A Retrospective Study in Nzérékoré Ebola Treatment Center, Guinea.
abstract: The 2014 Ebola epidemic has shown the importance of accurate and rapid triage tools for patients with suspected Ebola virus disease (EVD). Our objective was to create a predictive score for EVD. We retrospectively reviewed all suspected cases admitted to the Ebola treatment center (ETC) in Nzérékoré, Guinea, between December 2, 2014, and February 23, 2015. We used a multivariate logistic regression model to identify clinical and epidemiological factors associated with EVD, which were used to create a predictive score. A bootstrap sampling method was applied to our sample to determine characteristics of the score to discriminate EVD. Among the 145 patients included in the study (48% male, median age 29 years), EVD was confirmed in 76 (52%) patients. One hundred and eleven (77%) patients had at least one epidemiological risk factor. Optimal cutoff value of fever to discriminate EVD was 38.5°C. After adjustment on presence of a risk factor, temperature higher than 38.5°C (odds ratio [OR] = 18.1, 95% confidence interval [CI] = 7.6-42.9), and anorexia (OR = 2.5, 95% CI = 1.1-6.1) were independently associated with EVD. The score had an area under curve of 0.85 (95% CI = 0.78-0.91) for the prediction of laboratory-confirmed EVD. Classification of patients in a high-risk group according to the score had a lower sensitivity (71% versus 86%) but higher specificity (85% versus 41%) than the existing World Health Organization algorithm. This score, which requires external validation, may be used in high-prevalence settings to identify different levels of risk in EVD suspected patients and thus allow a better orientation in different wards of ETC.
authors.affiliation: Institut National de la Santé et de la Recherche Médicale (INSERM), Infection, Antimicrobiens, Modélisation, Evolution (IAME), Unité Mixte de Recherche (UMR) 1137, Paris, France. paul.loubet@aphp.fr.|Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Bichat-Claude Bernard, Service de Maladies Infectieuses et Tropicales, Paris, France.
authors.forename: Paul
authors.initials: P
authors.lastname: Loubet
authors.affiliation: Alliance for International Medical Action (ALIMA), Paris, France.
authors.forename: Romain
authors.initials: R
authors.lastname: Palich
authors.affiliation: Alliance for International Medical Action (ALIMA), Paris, France.
authors.forename: Richard
authors.initials: R
authors.lastname: Kojan
authors.affiliation: Alliance for International Medical Action (ALIMA), Paris, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Peyrouset
authors.affiliation: Programme PACCI, ANRS Research Site, Abidjan, Côte d'Ivoire.
authors.forename: Christine
authors.initials: C
authors.lastname: Danel
authors.affiliation: Epicentre, Médecins Sans Frontières, Paris, France.
authors.forename: Sarala
authors.initials: S
authors.lastname: Nicholas
authors.affiliation: Alliance for International Medical Action (ALIMA), Paris, France.
authors.forename: Mamoudou
authors.initials: M
authors.lastname: Conde
authors.affiliation: Epicentre, Médecins Sans Frontières, Paris, France.
authors.forename: Klaudia
authors.initials: K
authors.lastname: Porten
authors.affiliation: Alliance for International Medical Action (ALIMA), Paris, France.
authors.forename: Augustin
authors.initials: A
authors.lastname: Augier
authors.affiliation: Institut National de la Santé et de la Recherche Médicale (INSERM), Infection, Antimicrobiens, Modélisation, Evolution (IAME), Unité Mixte de Recherche (UMR) 1137, Paris, France.|Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Bichat-Claude Bernard, Service de Maladies Infectieuses et Tropicales, Paris, France.|Université Paris Diderot, Infection, Antimicrobiens, Modélisation, Evolution (IAME), Unité Mixte de Recherche (UMR) 1137, Paris, France.
authors.forename: Yazdan
authors.initials: Y
authors.lastname: Yazdanpanah
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D016701:Guinea / Q000453:epidemiology; D019142:Hemorrhagic Fever, Ebola / Q000453:epidemiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008954:Models, Biological; D012189:Retrospective Studies; D012307:Risk Factors; D012680:Sensitivity and Specificity; D012959:Socioeconomic Factors; D055815:Young Adult