Blood kinetics of Ebola virus in survivors and nonsurvivors
Blood kinetics of Ebola virus in survivors and nonsurvivors
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DOI：
10.1172/jci83111
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发表时间：
2015-12-01
影响因子：
15.9
通讯作者：
Ippolito, Giuseppe
中科院分区：
文献类型：
--
作者：
Lanini, Simone;Portella, Gina;Ippolito, Giuseppe
背景。感染埃博拉病毒（EBOV）会导致一种危及生命的疾病，据报告死亡率在50%-70%之间。人们对决定患者生存的因素了解甚少；然而，临床观察表明，EBOV病毒血症可能与致命结果有关。我们对埃博拉病毒病（EVD）患者的扎伊尔病毒血症动力学进行了研究，这些患者在最近的西非疫情期间在塞拉利昂的埃博拉治疗中心接受治疗。分析了84例EVD患者（38例幸存者，46例非幸存者）的数据，并在症状出现后2至13天对EBOV病毒血症进行了量化。症状出现的时间和临床结果作为独立变量来比较幸存者和非幸存者的EBOV病毒动力学。在所有患者中，EBOV病毒血症动力学是时间的二次函数；然而，从症状出现后第2天起，非幸存者的EBOV病毒血症为每毫升0.94对数（log）拷贝（P = 0.011），高于幸存者。与非幸存者相比，幸存者在症状出现后较早的时间达到峰值病毒血症水平（第5天vs第7天），并且与非幸存者相比，平均峰值病毒血症水平较低（7.46 log cp/ml; 95% CI, 7.17-7.76 vs 8.60 log cp/ml; 95% Cl, 8.27-8.93）。在达到峰值之前，埃博拉病毒血症在幸存者和非幸存者中同样增加；但存活者在峰值后病毒血症的衰减明显强于非存活者。我们的研究结果表明，在症状出现后非常早的时间点，幸存者和非幸存者之间的血浆EBOV浓度显着不同，这可能是预后的预测因素。需要对疾病早期阶段进行进一步的研究，以确定决定患者预后的因果和预后因素。
BACKGROUND. Infection with Ebola virus (EBOV) results in a life-threatening disease, with reported mortality rates between 50%-70%. The factors that determine patient survival are poorly understood; however, clinical observations indicate that EBOV viremia may be associated with fatal outcome. We conducted a study of the kinetics of Zaire EBOV viremia in patients with EBOV disease (EVD) who were managed at an Ebola Treatment Centre in Sierra Leone during the recent West African outbreak.METHODS. Data from 84 EVD patients (38 survivors, 46 nonsurvivors) were analyzed, and EBOV viremia was quantified between 2 and 13 days after symptom onset. Time since symptom onset and clinical outcome were used as independent variables to compare EBOV viral kinetics in survivors and nonsurvivors.RESULTS. In all patients, EBOV viremia kinetics was a quadratic function of time; however, EBOV viremia was 0.94 logarithm (log) copies per ml (pimp (P = 0.011) higher in nonsurvivors than in survivors from day 2 after the onset of symptoms. Survivors reached peak viremia levels at an earlier time after symptom onset than nonsurvivors (day 5 versus day 7) and had lower mean peak viremia levels compared with nonsunrivors (7.46 log cp/ml; 95% CI, 7.17-7.76 vs. 8.60 log cp/ml; 95% Cl, 8.27-8.93). Before reaching peak values, EBOV viremia similarly increased both in survivors and nonsurvivors; however, the decay of viremia after the peak was much stronger in survivors than in nonsurvivors.CONCLUSION. Our results demonstrate that plasma concentrations of EBOV are markedly different between survivors and nonsurvivors at very early time points after symptom onset and may be predicative of outcome. Further studies focused on the early phase of the disease will be required to identify the causal and prognostic factors that determine patient outcome.