U.K. Defence Medical Services EVD Group, Royal Centre for Defence Medicine, Birmingham, United Kingdom.
Royal Canadian Medical Services, Ottawa, Canada.
J Infect. 2018 Apr;76(4):383-392. doi: 10.1016/j.jinf.2017.12.006. Epub 2017 Dec 14.
Limited data exist describing supportive care management, laboratory abnormalities and outcomes in patients with Ebola virus disease (EVD) in West Africa. We report data which constitute the first description of the provision of enhanced EVD case management protocols in a West African setting.
Demographic, clinical and laboratory data were collected by retrospective review of clinical and laboratory records of patients with confirmed EVD admitted between 5 November 2014 and 30 June 2015.
A total of 44 EVD patients were admitted (median age 37 years (range 17-63), 32/44 healthcare workers), and excluding those evacuated, the case fatality rate was 49% (95% CI 33%-65%). No pregnant women were admitted. At admission 9/44 had stage 1 disease (fever and constitutional symptoms only), 12/44 had stage 2 disease (presence of diarrhoea and/or vomiting) and 23/44 had stage 3 disease (presence of diarrhoea and/or vomiting with organ failure), with case fatality rates of 11% (95% CI 1%-58%), 27% (95% CI 6%-61%), and 70% (95% CI 47%-87%) respectively (p = 0.009). Haemorrhage occurred in 17/41 (41%) patients. The majority (21/40) of patients had hypokalaemia with hyperkalaemia occurring in 12/40 patients. Acute kidney injury (AKI) occurred in 20/40 patients, with 14/20 (70%, 95% CI 46%-88%) dying, compared to 5/20 (25%, 95% CI 9%-49%) dying who did not have AKI (p = 0.01). Ebola virus (EBOV) PCR cycle threshold value at baseline was mean 20.3 (SD 4.3) in fatal cases and 24.8 (SD 5.5) in survivors (p = 0.007). Mean national early warning score (NEWS) at admission was 5.5 (SD 4.4) in fatal cases and 3.0 (SD 1.9) in survivors (p = 0.02). Central venous catheters were placed in 37/41 patients and intravenous fluid administered to 40/41 patients (median duration of 5 days). Faecal management systems were inserted in 21/41 patients, urinary catheters placed in 27/41 and blood component therapy administered to 20/41 patients.
EVD is commonly associated life-threatening electrolyte imbalance and organ dysfunction. We believe that the enhanced levels of protocolized care, scale and range of medical interventions we report, offer a blueprint for the future management of EVD in resource-limited settings.
在西非，有关埃博拉病毒病（EVD）患者的支持性护理管理、实验室异常和结局的数据有限。我们报告的数据首次描述了在西非环境中提供强化 EVD 病例管理方案的情况。
通过回顾性分析 2014 年 11 月 5 日至 2015 年 6 月 30 日期间确诊为 EVD 住院的患者的临床和实验室记录，收集人口统计学、临床和实验室数据。
共收治 44 例 EVD 患者（中位年龄 37 岁（范围 17-63 岁），32/44 例为医护人员），排除转移患者，病死率为 49%（95%CI 33%-65%）。无孕妇收治。入院时，9/44 例为 1 期疾病（仅发热和全身症状），12/44 例为 2 期疾病（腹泻和/或呕吐存在），23/44 例为 3 期疾病（腹泻和/或呕吐伴有器官衰竭），病死率分别为 11%（95%CI 1%-58%）、27%（95%CI 6%-61%）和 70%（95%CI 47%-87%）（p=0.009）。41%（17/41）的患者发生出血。大多数（21/40）患者出现低钾血症，12/40 例患者出现高钾血症。20/40 例患者发生急性肾损伤（AKI），14/20 例（70%，95%CI 46%-88%）死亡，而 20/20 例（5/20 例（25%，95%CI 9%-49%）未发生 AKI 患者死亡（p=0.01）。基线时死亡病例的 Ebola 病毒（EBOV）PCR 循环阈值值为 20.3（标准差 4.3），幸存者为 24.8（标准差 5.5）（p=0.007）。入院时，死亡病例的国家早期预警评分（NEWS）平均为 5.5（标准差 4.4），幸存者为 3.0（标准差 1.9）（p=0.02）。37/41 例患者置入中心静脉导管，40/41 例患者给予静脉补液（中位时间为 5 天）。21/41 例患者插入粪便管理系统，27/41 例患者留置导尿管，20/41 例患者给予血液成分治疗。
EVD 常伴有危及生命的电解质失衡和器官功能障碍。我们认为，我们报告的强化护理方案的水平、范围和医疗干预措施，为资源有限环境中 EVD 的未来管理提供了蓝图。
