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Laboratory Findings, Compassionate Use of Favipiravir, and Outcome in Patients With Ebola Virus Disease, Guinea, 2015-A Retrospective Observational Study.

ABSTRACT: BACKGROUND:In 2015, the laboratory at the Ebola treatment center in Coyah, Guinea, confirmed Ebola virus disease (EVD) in 286 patients. The cycle threshold (Ct) of an Ebola virus-specific reverse transcription-polymerase chain reaction assay and 13 blood chemistry parameters were measured on admission and during hospitalization. Favipiravir treatment was offered to patients with EVD on a compassionate-use basis. METHODS:To reduce biases in the raw field data, we carefully selected 163 of 286 patients with EVD for a retrospective study to assess associations between potential risk factors, alterations in blood chemistry findings, favipiravir treatment, and outcome. RESULTS:The case-fatality rate in favipiravir-treated patients was lower than in untreated patients (42.5% [31 of 73] vs 57.8% [52 of 90]; P = .053 by univariate analysis). In multivariate regression analysis, a higher Ct and a younger age were associated with survival (P < .001), while favipiravir treatment showed no statistically significant effect (P = .11). However, Kaplan-Meier analysis indicated a longer survival time in the favipiravir-treated group (P = .015). The study also showed characteristic changes in blood chemistry findings in patients who died, compared with survivors. CONCLUSIONS:Consistent with the JIKI trial, this retrospective study revealed a trend toward improved survival in favipiravir- treated patients; however, the effect of treatment was not statistically significant, except for its influence on survival time.

SUBMITTER: Kerber R

PROVIDER: S-EPMC6581890 | biostudies-other | 2019 Jun

REPOSITORIES: biostudies-other

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Laboratory Findings, Compassionate Use of Favipiravir, and Outcome in Patients With Ebola Virus Disease, Guinea, 2015-A Retrospective Observational Study.

Kerber Romy R Lorenz Eva E Duraffour Sophie S Sissoko Daouda D Rudolf Martin M Jaeger Anna A Cisse Sekou Ditinn SD Camara Alseny-Modet AM Miranda Osvaldo O Castro Carlos M CM Akoi Bore Joseph J Raymond Koundouno Fara F Repits Johanna J Afrough Babak B Becker-Ziaja Beate B Hinzmann Julia J Mertens Marc M Vitoriano Ines I Hugh Logue Christopher C Böttcher Jan-Peter JP Pallasch Elisa E Sachse Andreas A Bah Amadou A Cabeza-Cabrerizo Mar M Nitzsche Katja K Kuisma Eeva E Michel Janine J Holm Tobias T Zekeng Elsa Gayle EG Cowley Lauren A LA Garcia-Dorival Isabel I Hetzelt Nicole N Baum Jonathan Hans Josef JHJ Portmann Jasmine J Carter Lisa L Yenamaberhan Rahel Lemma RL Camino Alvaro A Enkirch Theresa T Singethan Katrin K Meisel Sarah S Mazzarelli Antonio A Kosgei Abigail A Kafetzopoulou Liana L Rickett Natasha Y NY Patrono Livia Victoria LV Ghebreghiorghis Luam L Arnold Ulrike U Colin Géraldine G Juchet Sylvain S Marchal Claire Levy CL Kolie Jacques Seraphin JS Beavogui Abdoul Habib AH Wurr Stephanie S Bockholt Sabrina S Krumkamp Ralf R May Jürgen J Stoecker Kilian K Fleischmann Erna E Ippolito Giuseppe G Carroll Miles W MW Koivogui Lamine L Magassouba N'Faly N Keita Sakoba S Gurry Céline C Drury Patrick P Diallo Boubacar B Formenty Pierre P Wölfel Roman R Di Caro Antonino A Gabriel Martin M Anglaret Xavier X Malvy Denis D Günther Stephan S

The Journal of infectious diseases 20190601 2

<h4>Background</h4>In 2015, the laboratory at the Ebola treatment center in Coyah, Guinea, confirmed Ebola virus disease (EVD) in 286 patients. The cycle threshold (Ct) of an Ebola virus-specific reverse transcription-polymerase chain reaction assay and 13 blood chemistry parameters were measured on admission and during hospitalization. Favipiravir treatment was offered to patients with EVD on a compassionate-use basis.<h4>Methods</h4>To reduce biases in the raw field data, we carefully selected ...[more]

PMID: 30788508

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Project description:BackgroundLassa fever is a viral haemorrhagic disease endemic to west Africa. No large-scale studies exist from Nigeria, where the Lassa virus (LASV) is most diverse. LASV diversity, coupled with host genetic and environmental factors, might cause differences in disease pathophysiology. Small-scale studies in Nigeria suggest that acute kidney injury is an important clinical feature and might be a determinant of survival. We aimed to establish the demographic, clinical, and laboratory factors associated with mortality in Nigerian patients with Lassa fever, and hypothesised that LASV was the direct cause of intrinsic renal damage for a subset of the patients with Lassa fever.MethodsWe did a retrospective, observational cohort study of consecutive patients in Nigeria with Lassa fever, who tested positive for LASV with RT-PCR, and were treated in Irrua Specialist Teaching Hospital. We did univariate and multivariate statistical analyses, including logistic regression, of all demographic, clinical, and laboratory variables available at presentation to identify the factors associated with patient mortality.FindingsOf 291 patients treated in Irrua Specialist Teaching Hospital between Jan 3, 2011, and Dec 11, 2015, 284 (98%) had known outcomes (died or survived) and seven (2%) were discharged against medical advice. Overall case-fatality rate was 24% (68 of 284 patients), with a 1·4 times increase in mortality risk for each 10 years of age (p=0·00017), reaching 39% (22 of 57) for patients older than 50 years. Of 284 patients, 81 (28%) had acute kidney injury and 104 (37%) had CNS manifestations and thus both were considered important complications of acute Lassa fever in Nigeria. Acute kidney injury was strongly associated with poor outcome (case-fatality rate of 60% [49 of 81 patients]; odds ratio [OR] 15, p<0·00001). Compared with patients without acute kidney injury, those with acute kidney injury had higher incidence of proteinuria (32 [82%] of 39 patients) and haematuria (29 [76%] of 38) and higher mean serum potassium (4·63 [SD 1·04] mmol/L) and lower blood urea nitrogen to creatinine ratio (8·6 for patients without clinical history of fluid loss), suggesting intrinsic renal damage. Normalisation of creatinine concentration was associated with recovery. Elevated serum creatinine (OR 1·3; p=0·046), aspartate aminotransferase (OR 1·5; p=0·075), and potassium (OR 3·6; p=0·0024) were independent predictors of death.InterpretationOur study presents detailed clinical and laboratory data for Nigerian patients with Lassa fever and provides strong evidence for intrinsic renal dysfunction in acute Lassa fever. Early recognition and treatment of acute kidney injury might significantly reduce mortality.FundingGerman Research Foundation, German Center for Infection Research, Howard Hughes Medical Institute, US National Institutes of Health, and World Bank.

Dataset Information

Laboratory Findings, Compassionate Use of Favipiravir, and Outcome in Patients With Ebola Virus Disease, Guinea, 2015-A Retrospective Observational Study.

Publications

Laboratory Findings, Compassionate Use of Favipiravir, and Outcome in Patients With Ebola Virus Disease, Guinea, 2015-A Retrospective Observational Study.

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