Weppelmann Thomas A, Donewell Bangure, Haque Ubydul, Hu Wenbiao, Magalhaes Ricardo J Soares, Lubogo Mutaawe, Godbless Lucas, Shabani Sasita, Maeda Justin, Temba Herilinda, Malibiche Theophil C, Berhanu Naod, Zhang Wenyi, Bawo Luke
Department of Environmental and Global Health, University of Florida, Gainesville, FL USA.
Emerging Pathogens Institute, University of Florida, 2055 Mowry Rd, Gainesville, FL USA.
Glob Health Res Policy. 2016 Jun 23;1:5. doi: 10.1186/s41256-016-0005-8. eCollection 2016.
The unprecedented size of the 2014 Ebola Virus Disease (EVD) outbreak in West Africa has allowed for a more extensive characterization of the clinical presentation and management of this disease. In this study, we report the trends in morbidity, mortality, and determinants of patient survival as EVD spread into Bong County, Liberia.
An analysis of suspected, probable, or confirmed cases of EVD ( = 607) reported to the Liberian Ministry of Health and Social Welfare (MOHSW) between March 23 and December 31 2014 was conducted. The likelihood of infection given exposure factors was determined using logistic regression in individuals with a definitive diagnosis by RT-PCR ( = 321). The risk of short-term mortality (30 days) given demographic factors, clinical symptoms, and highest level of treatment received was assessed with Cox regression and survival analyses ( = 391).
The overall mortality rate was 53.5 % (95 % CI: 49 %, 58 %) and decreased as access to medical treatment increased. Those who reported contact with another EVD case were more likely to be infected (OR: 5.7), as were those who attended a funeral (OR: 3.9). Mortality increased with age ( < 0.001) and was higher in males compared to females ( =0.006). Fever (HR: 6.63), vomiting (HR: 1.93), diarrhea (HR: 1.99), and unexplained bleeding (HR: 2.17) were associated with increased mortality. After adjusting for age, hospitalized patients had a 74 % reduction in the risk of short term mortality ( < 0.001 AHR: 0.26; 95 % CI AHR: 0.18, 0.37), compared to those not given medical intervention.
Even treatment with only basic supportive care such as intravenous rehydration therapy was able to significantly improve patient survival in suspected, probable, or confirmed EVD cases.
2014年西非埃博拉病毒病（EVD）疫情规模空前，使得对该疾病临床表现及治疗方法的特征描述更为详尽。在本研究中，我们报告了埃博拉病毒病蔓延至利比里亚邦县时的发病率、死亡率趋势以及患者生存的决定因素。
对2014年3月23日至12月31日期间向利比里亚卫生和社会福利部（MOHSW）报告的607例疑似、可能或确诊的埃博拉病毒病病例进行了分析。通过RT-PCR确诊的个体（n = 321），采用逻辑回归确定暴露因素导致感染的可能性。通过Cox回归和生存分析（n = 391）评估人口统计学因素、临床症状和接受的最高治疗水平导致短期（30天）死亡的风险。
总体死亡率为53.5%（95%CI：49%，58%），且随着获得医疗救治机会的增加而降低。报告与另一例埃博拉病毒病病例有接触的人感染可能性更大（OR：5.7），参加葬礼的人也是如此（OR：3.9）。死亡率随年龄增长而增加（P < 0.001），男性死亡率高于女性（P = 0.006）。发热（HR：6.63）、呕吐（HR：1.93）、腹泻（HR：1.99）和不明原因出血（HR：2.17）与死亡率增加相关。在调整年龄因素后，与未接受医疗干预的患者相比，住院患者短期死亡风险降低了74%（P < 0.001，AHR：0.26；95%CI AHR：0.18，0.37）。
即使仅采用静脉补液治疗等基本支持性护理进行治疗，也能显著提高疑似、可能或确诊的埃博拉病毒病病例患者的生存率。
