The natural history of acute Ebola Virus Disease among patients managed in five Ebola treatment units in West Africa: A retrospective cohort study.
The natural history of acute Ebola Virus Disease among patients managed in five Ebola treatment units in West Africa: A retrospective cohort study.
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西非五个埃博拉治疗单位管理的患者急性埃博拉病毒病的自然史：一项回顾性队列研究。
DOI：
10.1371/journal.pntd.0005700
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发表时间：
2017-07
影响因子：
3.8
通讯作者：
Levine AC
中科院分区：
文献类型：
--
作者：
Skrable K;Roshania R;Mallow M;Wolfman V;Siakor M;Levine AC
此前对埃博拉病毒病 (EVD) 的研究主要集中在临床症状和患者分类时记录的埃博拉病毒 (EBOV) 周期阈值 (CT) 值。我们的研究探讨了不同人群从发病到康复或死亡的 EVD 症状和 EBOV CT 值。我们分析了 2014 年至 2015 年西非五个埃博拉治疗中心收治的 EBOV 阳性患者的临床护理数据。使用描述性统计数据探讨临床体征/症状和 CT 值的发生率。使用逻辑回归来检查它们与死亡率的关联。使用 Kaplan-Meier 估计器分析从症状出现日期到死亡的生存率。在患病第一周，呼吸困难（OR = 2.44，95% CI：1.07–5.85）和心动过速（OR = 10.22，95% CI：2.20–56.71）与较高的死亡率相关。病程中任何时刻的呼吸困难（OR = 2.33，95% CI：1.210–4.581）、出血（OR = 2.51，95% CI：1.219–5.337）和腹泻（OR = 2.79，95% CI：1.171–6.970）与较高的死亡率相关。较高的初始（OR = 0.85，95% CI：0.81–0.89）和平均（OR = 0.60，95% CI：0.53–0.66）CT 值与较低的死亡率相关。患病 3-5 天后 CT 值达到最低点，然后幸存者和非幸存者的 CT 值均上升，直至康复或死亡。我们的研究表明，在大量不同的埃博拉病毒病患者群体中，随着时间的推移，临床体征/症状和 EBOV CT 值的人群患病率，以及症状/EBOV CT 值与死亡率之间的关联。这些发现对未来埃博拉病毒病疫情的监测、行动规划和临床护理具有影响。以前对埃博拉病毒病（EVD）的研究主要集中在患者开始医疗护理当天测量的临床症状和血液中的病毒载量（或其周期阈值的代表）。然而，这提供了疾病的单一及时快照，并且没有表明体征/症状和周期阈值如何随时间变化。这项研究检查了埃博拉病毒病患者从发病到康复或死亡的症状和埃博拉病毒循环阈值。研究的患者在一年内入住西非的五个治疗单位。作者发现，最年轻（五岁以下）和最年长（45 岁及以上）的患者在埃博拉病毒感染后存活下来的可能性最小。此外，患者寻求治疗时血液中病毒水平较高以及患病期间病毒水平较高与生存率较低有关。这些发现为了解埃博拉病毒病随时间的进展提供了重要见解，并将帮助临床医生和其他卫生工作者为更有可能死于埃博拉病毒感染的患者亚组确定和设计干预措施。
Previous studies of Ebola Virus Disease (EVD) have focused on clinical symptoms and Ebola virus (EBOV) cycle threshold (CT) values recorded at patient triage. Our study explores EVD symptoms and EBOV CT values from onset of illness to recovery or death in a diverse population of patients. We analyzed clinical care data from EBOV positive patients admitted to five Ebola treatment units in West Africa from 2014–2015. Prevalence of clinical signs/symptoms and CT values were explored using descriptive statistics. Logistic regression was used to examine their association with mortality. Survival was analyzed using Kaplan-Meier estimators from symptom onset date to death. During the first week of illness, dyspnea (OR = 2.44, 95% CI: 1.07–5.85) and tachycardia (OR = 10.22, 95% CI: 2.20–56.71) were associated with higher odds of mortality. Dyspnea (OR = 2.33, 95% CI: 1.210–4.581), bleeding (OR = 2.51, 95% CI: 1.219–5.337), and diarrhoea (OR = 2.79, 95% CI: 1.171–6.970) at any point during the illness course were associated with higher odds of mortality. Higher initial (OR = 0.85, 95% CI: 0.81–0.89) and mean (OR = 0.60, 95% CI: 0.53–0.66) CT values were associated with lower odds of mortality. CT values reached their nadir after 3–5 days of illness and then rose in both survivors and non-survivors until recovery or death. Our study demonstrates the population prevalence of clinical signs/symptoms and EBOV CT values over time in a large, diverse cohort of patients with EVD, as well as associations between symptoms/EBOV CT values and mortality. These findings have implications on surveillance, operational planning, and clinical care for future EVD outbreaks. Previous studies of Ebola Virus Disease (EVD) have focused on clinical symptoms and viral load (or its proxy of cycle threshold value) in the blood of patients measured the day they begin medical care. However, this provides a single snapshot of the illness in time and does not indicate how signs/symptoms and cycle threshold values change over time. This study examined EVD symptoms and the Ebola virus cycle threshold values in patients from the time the illness started to the time they recovered or died. The patients studied were admitted to five treatment units in West Africa over a one-year period. The authors found that the youngest (under five) and oldest (45 and older) patients were least likely to survive EBOV infection. In addition, higher levels of virus in the blood at the time patients sought treatment as well as higher virus levels over the duration of their illness were associated with lower survival. These findings provide important insight into the progression of EVD over time and will help clinicians and other health workers to identify and design interventions for subgroups of patients who are more likely to die from EBOV infection.
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影响因子：
11.8
作者：
Qin, Enqiang;Bi, Jingfeng;Zhong, Yanwei
通讯作者：
Zhong, Yanwei
影响因子：
3.8
作者：
Zhang X;Rong Y;Sun L;Liu L;Su H;Zhang J;Teng G;Du N;Chen H;Fang Y;Zhan W;Kanu AB;Koroma SM;Jin B;Xu Z;Song H
通讯作者：
Song H
DOI：
10.1056/nejmoa1411100
发表时间：
2014-10-16
期刊：
The New England journal of medicine
影响因子：
--
作者：
WHO Ebola Response Team;Aylward B;Barboza P;Bawo L;Bertherat E;Bilivogui P;Blake I;Brennan R;Briand S;Chakauya JM;Chitala K;Conteh RM;Cori A;Croisier A;Dangou JM;Diallo B;Donnelly CA;Dye C;Eckmanns T;Ferguson NM;Formenty P;Fuhrer C;Fukuda K;Garske T;Gasasira A;Gbanyan S;Graaff P;Heleze E;Jambai A;Jombart T;Kasolo F;Kadiobo AM;Keita S;Kertesz D;Koné M;Lane C;Markoff J;Massaquoi M;Mills H;Mulba JM;Musa E;Myhre J;Nasidi A;Nilles E;Nouvellet P;Nshimirimana D;Nuttall I;Nyenswah T;Olu O;Pendergast S;Perea W;Polonsky J;Riley S;Ronveaux O;Sakoba K;Santhana Gopala Krishnan R;Senga M;Shuaib F;Van Kerkhove MD;Vaz R;Wijekoon Kannangarage N;Yoti Z
通讯作者：
Yoti Z
DOI：
10.1056/nejmoa1604330
发表时间：
2016-10-13
期刊：
The New England journal of medicine
影响因子：
--
作者：
PREVAIL II Writing Group;Multi-National PREVAIL II Study Team;Davey RT Jr;Dodd L;Proschan MA;Neaton J;Neuhaus Nordwall J;Koopmeiners JS;Beigel J;Tierney J;Lane HC;Fauci AS;Massaquoi MBF;Sahr F;Malvy D
通讯作者：
Malvy D
影响因子：
5.4
作者：
Towner, JS;Rollin, PE;Nichol, ST
通讯作者：
Nichol, ST