Evaluation of Management Strategies for Maximizing Supportive Care for Patients with Ebola Virus Disease

项目摘要 自1976年以来，已经有近20起埃博拉病毒病（EVD）的确诊疫情，全部起源于 撒哈拉以南非洲最近在西非爆发的疫情是迄今为止规模最大的，导致近3万人死亡。 EVD疑似和确诊病例以及12，000例死亡。尽管几内亚、利比里亚和塞拉利昂 占绝大多数病例，从这些国家输入的感染被确定在7个 其他国家，包括美国。最近发生的恐怖主义的规模和地理范围 EVD的流行，加上其高总体死亡率，突出了未来EVD对全球健康构成的威胁。 疾病暴发和相关的更好的管理战略的需要，以提高疾病的生存。 然而，仍然缺乏关于各种临床干预措施的有效性的高质量数据， EVD，迄今为止，还没有多中心研究评估常用的支持性治疗的影响。 以病人为中心的结果的护理和治疗模式。2014年9月至12月 2015年，人道主义组织国际医疗团（IMC）管理着五个埃博拉治疗单位， 利比里亚和塞拉利昂的ETU治疗了2，500多名患者，其中包括470名确诊的EVD患者。 IMC从这些网站收集了超过25，000页的临床、实验室和操作数据。之前 在ETU关闭后，IMC经历了提取、数字化、聚合和质量的艰苦工作， 检查这些数据。这一广泛的过程产生了一个独特的数据库，现在可以用来评估 特定临床干预对EVD感染者以患者为中心的结局的影响 个体使用先进的统计方法，各种支持性护理干预措施的影响， 包括补液疗法、微量营养素补充剂和抗菌剂，对死亡率和持续时间的影响 将评估EVD感染患者的症状。这项研究有可能改善 国际EVD指南的循证基础，确定未来潜在的高产干预措施 在对照试验中进行研究，并提高对未来EVD流行病的总体反应质量。

PROJECT SUMMARY Since 1976, there have been nearly 20 confirmed outbreaks of Ebola Virus Disease (EVD), all originating in sub-Saharan Africa. The most recent outbreak in West Africa was by far the largest, leading to nearly 30,000 suspected and confirmed cases of EVD and 12,000 deaths. Although Guinea, Liberia, and Sierra Leone accounted for the vast majority of cases, infections imported from these countries were identified in seven additional countries, including the United States. The magnitude and geographic breadth of the recent epidemic, coupled with its high overall mortality, highlights the global health dangers posed by future EVD outbreaks and the associated need for better management strategies in order to improve disease survival. However, there remains a lack of high-quality data on the efficacy of various clinical interventions for EVD, and to date no multisite studies exist evaluating the impacts of commonly utilized supportive care and treatment modalities on patient-centered outcomes. Between September 2014 and December 2015, the humanitarian organization International Medical Corps (IMC) managed five Ebola Treatment Units (ETUs) in Liberia and Sierra Leone, which cared for over 2,500 patients, including 470 with confirmed EVD. From these sites, IMC collected over 25,000 pages of clinical, laboratory, and operational data. Prior to the closure of the ETUs, IMC underwent the painstaking work of extracting, digitizing, aggregating, and quality checking this data. This extensive process yielded a unique database that can now be used to evaluate the impacts of specific clinical interventions on patient-centered outcomes among EVD infected individuals. Using advanced statistical methodologies, the impacts of various supportive care interventions, including rehydration therapies, micronutrient supplementation, and antimicrobials, on mortality and duration of symptoms in EVD-infected patients will be evaluated. This research has the potential to improve the evidence-base for international EVD guidelines, identify potentially high-yield interventions for future study in controlled trials, and improve the quality of the overall response to future EVD epidemics.