Vitamin A Supplementation Was Associated with Reduced Mortality in Patients with Ebola Virus Disease during the West African Outbreak
Vitamin A Supplementation Was Associated with Reduced Mortality in Patients with Ebola Virus Disease during the West African Outbreak
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DOI：
10.1093/jn/nxz142
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发表时间：
2019-10-01
影响因子：
4.2
通讯作者：
Levine, Adam C.
中科院分区：
文献类型：
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作者：
Aluisio, Adam R.;Perera, Shiromi M.;Levine, Adam C.
背景资料：在埃博拉病毒病（EVD）中推荐补充微量营养素;然而，关于特定微量营养素治疗效果的数据有限。Objective：评估维生素A补充与EVD.Methods死亡率之间的关联：该回顾性队列包括2014-2015年期间在2个国家的5个国际医疗团埃博拉治疗单位（ETUs）收治的EVD患者。所有ETU均使用微量营养素方案治疗：然而，由于资源限制，只有一部分患者接受了维生素A。收集了人口统计学、临床特征、疟疾状态和埃博拉病毒载量（周期阈值）的标准化数据。研究结果为在第1天和/或第2天接受200，000 IU维生素A治疗的病例与未接受200，000 IU维生素A治疗的病例的死亡率。使用年龄、ETU持续时间、疟疾状态、周期阈值和临床症状等协变量得出基于护理的前48小时的倾向评分。患者使用最近邻与替换进行1：1匹配。结果：共分析424例，其中维生素A治疗组330例（77.8%），维生素A治疗组330例（77.8%）。平均年龄为30.5岁，40.3%为男性。最常见的不良反应为腹泻（85.6%）、厌食（80.7%）和腹痛（76.9%）。维生素A治疗组和未治疗组的死亡率分别为55.0%和71.9%。在倾向匹配分析中，接受维生素A治疗的病例死亡率显著降低（RR = 0.77，95%CI：0.59，0.99; P = 0.041）。在一个亚组分析的患者已经含有维生素A的多种维生素治疗，额外的维生素A补充剂并没有影响mortality.Conclusion：早期维生素A补充剂与EVD患者的死亡率降低，并应进一步研究，并考虑在未来的流行病中使用。
Background: Micronutrient supplementation is recommended in Ebola virus disease (EVD); however, there are limited data on therapeutic impacts of specific micronutrients.Objective: To evaluate the association between vitamin A supplementation and mortality in EVD.Methods: This retrospective cohort included patients with EVD admitted to 5 International Medical Corps Ebola Treatment Units (ETUs) in 2 countries during 2014-2015. Protocolized treatments with micronutrients were used at all ETUs: however, because of resource constraints, only a subset of patients received vitamin A. Standardized data on demographics, clinical characteristics, malaria status, and Ebola viral loads (cycle threshold values) were collected. The outcome of interestwasmortality between cases treated with 200,000 IU of vitamin A on care days 1 and/or 2, and those not. Propensity scores based on the first 48 h of care were derived using covariates of age, ETU duration, malaria status, cycle threshold values, and clinical symptoms. Patients were matched 1: 1 using nearest neighbors with replacement. Mortality between cases treated and not treated with vitamin A was compared using generalized estimating equations to calculate RR with associated 95% CI.Results: There were 424 cases analyzed, of which 330 (77.8%) were treated with vitamin A. The mean age was 30.5 y and 40.3% were men. Themost common symptomswere diarrhea (85.6%), anorexia (80.7%), and abdominal pain (76.9%). Mortality proportions among cases treated and not treated with vitamin A were 55.0% and 71.9%, respectively. In the propensity-matched analysis, mortality was significantly lower among cases receiving vitamin A (RR = 0.77, 95% CI: 0.59, 0.99; P = 0.041). In a subgroup analysis of patients treated with multivitamins already containing vitamin A, additional vitamin A supplementation did not impact mortality.Conclusion: Early vitamin A supplementation was associated with reduced mortality in patients with EVD, and should be further studied and considered for use in future epidemics.