Predicting Ebola Severity: A Clinical Prioritization Score for Ebola Virus Disease.

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Version: Final published version
Serval ID
serval:BIB_A5F4C49BCC07
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Predicting Ebola Severity: A Clinical Prioritization Score for Ebola Virus Disease.
Journal
PLoS neglected tropical diseases
Author(s)
Hartley M.A., Young A., Tran A.M., Okoni-Williams H.H., Suma M., Mancuso B., Al-Dikhari A., Faouzi M.
ISSN
1935-2735 (Electronic)
ISSN-L
1935-2727
Publication state
Published
Issued date
02/2017
Peer-reviewed
Oui
Volume
11
Number
2
Pages
e0005265
Language
english
Notes
Publication types: Journal Article
Publication Status: epublish
Abstract
Despite the notoriety of Ebola virus disease (EVD) as one of the world's most deadly infections, EVD has a wide range of outcomes, where asymptomatic infection may be almost as common as fatality. With increasingly sensitive EVD diagnosis, there is a need for more accurate prognostic tools that objectively stratify clinical severity to better allocate limited resources and identify those most in need of intensive treatment.
This retrospective cohort study analyses the clinical characteristics of 158 EVD(+) patients at the GOAL-Mathaska Ebola Treatment Centre, Sierra Leone. The prognostic potential of each characteristic was assessed and incorporated into a statistically weighted disease score. The mortality rate among EVD(+) patients was 60.8% and highest in those aged <5 or >25 years (p<0.05). Death was significantly associated with malaria co-infection (OR = 2.5, p = 0.01). However, this observation was abrogated after adjustment to Ebola viral load (p = 0.1), potentially indicating a pathologic synergy between the infections. Similarly, referral-time interacted with viral load, and adjustment revealed referral-time as a significant determinant of mortality, thus quantifying the benefits of early reporting as a 12% mortality risk reduction per day (p = 0.012). Disorientation was the strongest unadjusted predictor of death (OR = 13.1, p = 0.014) followed by hiccups, diarrhoea, conjunctivitis, dyspnoea and myalgia. Including these characteristics in multivariate prognostic scores, we obtained a 91% and 97% ability to discriminate death at or after triage respectively (area under ROC curve).
This study proposes highly predictive and easy-to-use prognostic tools, which stratify the risk of EVD mortality at or after EVD triage.

Keywords
Adolescent, Adult, Child, Ebolavirus/genetics, Ebolavirus/physiology, Female, Hemorrhagic Fever, Ebola/diagnosis, Hemorrhagic Fever, Ebola/mortality, Hemorrhagic Fever, Ebola/virology, Humans, Male, Prognosis, Retrospective Studies, Sierra Leone, Young Adult
Pubmed
Web of science
Open Access
Yes
Create date
14/02/2017 11:32
Last modification date
20/08/2019 15:11
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