埃博拉病毒病患者补充多种维生素与死亡率之间的关联：一项国际多中心队列研究。

Association between multivitamin supplementation and mortality among patients with Ebola virus disease: An international multisite cohort study.

作者信息

Yam Derrick, Aluisio Adam R, Perera Shiromi M, Peters Jillian L, Cho Daniel K, Kennedy Stephen B, Massaquoi Moses, Sahr Foday, Smit Michael A, Locks Lindsey, Liu Tao, Levine Adam C

机构信息

Center for Statistical Sciences, Department of Biostatistics, Brown University School of Public Health, Providence, RI, USA.

Department of Emergency Medicine, Brown University Alpert Medical School, Providence, RI, USA.

出版信息

Afr J Emerg Med. 2020 Mar;10(1):23-29. doi: 10.1016/j.afjem.2019.11.001. Epub 2020 Jan 3.

DOI:10.1016/j.afjem.2019.11.001

PMID:32161708

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7058859/

Abstract

INTRODUCTION

Micronutrient supplementation is recommended in Ebola Virus Disease (EVD) care; however, there is limited data on its therapeutic effects.

METHODS

This retrospective cohort study included patients with EVD admitted to five Ebola Treatment Units (ETU) in Sierra Leone and Liberia during September 2014 to December 2015. A uniform protocol was used to guide ETU care, however, due to supply limitations, only a subset of patients received multivitamins. Data on demographics, clinical characteristics, and laboratory testing was collected. The outcome of interest was facility-based mortality and the primary predictor was multivitamin supplementation initiated within 48 h of admission. The multivitamin formulations included: thiamine, riboflavin, niacin and vitamins A, C, and D. Propensity score models (PSM) were used to match patients based on covariates associated with multivitamin administration and mortality. Mortality between cases treated and untreated within 48 h of admission were compared using generalized estimating equations to calculate relative risk with bootstrap methods employed to assess statistical significance.

RESULTS

There were 424 patients with EVD who had sufficient treatment data for analysis, of which 261 (61.6%) had daily multivitamins initiated within 48 h of admission. The mean age of the cohort was 30.5 years and 59.4% were female. In the propensity score matched analysis, mortality was 53.5% among patients receiving multivitamins and 66.2% among patients not receiving multivitamins, resulting in a relative risk for mortality of 0.81 (p = 0.03) for patients receiving multivitamins.

CONCLUSION

Early multivitamin supplementation was associated with lower overall mortality. Further research on the impact of micronutrient supplementation in EVD is warranted.

摘要

引言

在埃博拉病毒病（EVD）护理中建议补充微量营养素；然而，关于其治疗效果的数据有限。

方法

这项回顾性队列研究纳入了2014年9月至2015年12月期间在塞拉利昂和利比里亚的五个埃博拉治疗单元（ETU）收治的EVD患者。采用统一方案指导ETU护理，但由于供应限制，只有一部分患者接受了多种维生素。收集了人口统计学、临床特征和实验室检查数据。感兴趣的结局是机构内死亡率，主要预测因素是入院后48小时内开始补充多种维生素。多种维生素制剂包括：硫胺素、核黄素、烟酸以及维生素A、C和D。倾向评分模型（PSM）用于根据与多种维生素给药和死亡率相关的协变量对患者进行匹配。使用广义估计方程比较入院后48小时内接受治疗和未接受治疗的病例之间的死亡率，采用自助法计算相对风险以评估统计学意义。

结果

有424例EVD患者有足够的治疗数据进行分析，其中261例（61.6%）在入院后48小时内开始每日补充多种维生素。该队列的平均年龄为30.5岁，59.4%为女性。在倾向评分匹配分析中，接受多种维生素的患者死亡率为53.5%，未接受多种维生素的患者死亡率为66.2%，接受多种维生素的患者死亡率相对风险为0.81（p = 0.03）。