开发PREDS评分以预测接受高级支持治疗的埃博拉病毒病患者的院内死亡率：刚果民主共和国EVISTA队列研究结果
Development of the PREDS score to predict in-hospital mortality of patients with Ebola virus disease under advanced supportive care: Results from the EVISTA cohort in the Democratic Republic of the Congo.
作者信息
Jaspard Marie, Mulangu Sabue, Juchet Sylvain, Serra Beatrice, Dicko Ibrahim, Lang Hans-Joeg, Baka Baweye Mayoum, Komanda Gaston Musemakweli, Katsavara Jeremie Muhindo, Kabuni Patricia, Mambu Fabrice Mbika, Isnard Margaux, Vanhecke Christophe, Letord Alexia, Dieye Ibrahima, Patterson-Lomba Oscar, Mbaya Olivier Tshiani, Isekusu Fiston, Mangala Donatien, Biampata Jean Luc, Kitenge Richard, Kinda Moumouni, Anglaret Xavier, Muyembe Jean Jacques, Kojan Richard, Ezzedine Khaled, Malvy Denis
机构信息
Alliance for International Medical Action (ALIMA), Dakar, Senegal.
University of Bordeaux, National Institute for Health and Medical Research (Inserm), Research Institute for Sustainable Development (IRD), Bordeaux Population Health Center, UMR 1219, Bordeaux, France.
出版信息
EClinicalMedicine. 2022 Oct 13;54:101699. doi: 10.1016/j.eclinm.2022.101699. eCollection 2022 Dec.
BACKGROUND
As mortality remains high for patients with Ebola virus disease (EVD) despite new treatment options, the ability to level up the provided supportive care and to predict the risk of death is of major importance. This analysis of the EVISTA cohort aims to describe advanced supportive care provided to EVD patients in the Democratic Republic of the Congo (DRC) and to develop a simple risk score for predicting in-hospital death, called PREDS.
METHODS
In this prospective cohort (NCT04815175), patients were recruited during the 10 EVD outbreak in the DRC across three Ebola Treatment Centers (ETCs). Demographic, clinical, biological, virological and treatment data were collected. We evaluated factors known to affect the risk of in-hospital death and applied univariate and multivariate Cox proportional-hazards analyses to derive the risk score in a training dataset. We validated the score in an internal-validation dataset, applying C-statistics as a measure of discrimination.
FINDINGS
Between August 1 2018 and December 31 2019, 711 patients were enrolled in the study. Regarding supportive care, patients received vasopressive drug ( = 111), blood transfusion ( = 101), oxygen therapy ( = 250) and cardio-pulmonary ultrasound ( = 15). Overall, 323 (45%) patients died before day 28. Six independent prognostic factors were identified (ALT, creatinine, modified NEWS2 score, viral load, age and symptom duration). The final score range from 0 to 13 points, with a good concordance (C = 86.24%) and calibration with the Hosmer-Lemeshow test ( = 0.12).
INTERPRETATION
The implementation of advanced supportive care is possible for EVD patients in emergency settings. PREDS is a simple, accurate tool that could help in orienting early advanced care for at-risk patients after external validation.
FUNDING
This study was funded by ALIMA.
背景
尽管有了新的治疗方案，埃博拉病毒病（EVD）患者的死亡率仍然很高，因此加强所提供的支持性护理以及预测死亡风险的能力至关重要。对埃博拉病毒感染支持治疗评估（EVISTA）队列的这项分析旨在描述为刚果民主共和国（DRC）的埃博拉病毒病患者提供的高级支持性护理，并开发一种用于预测院内死亡的简单风险评分，称为PREDS。
方法
在这个前瞻性队列研究（NCT04815175）中，在刚果民主共和国的10次埃博拉疫情期间，通过三个埃博拉治疗中心（ETC）招募患者。收集了人口统计学、临床、生物学、病毒学和治疗数据。我们评估了已知会影响院内死亡风险的因素，并应用单变量和多变量Cox比例风险分析在一个训练数据集中得出风险评分。我们在一个内部验证数据集中验证了该评分，应用C统计量作为区分度的度量。
结果
在2018年8月1日至2019年12月31日期间，711名患者被纳入研究。关于支持性护理，患者接受了血管活性药物治疗（n = 111）、输血（n = 101）、氧疗（n = 250）和心肺超声检查（n = 15）。总体而言，323名（45%）患者在第28天前死亡。确定了六个独立的预后因素（谷丙转氨酶、肌酐、改良的国家早期预警评分2、病毒载量、年龄和症状持续时间）。最终评分范围为0至13分，具有良好的一致性（C = 86.24%），并且通过Hosmer-Lemeshow检验校准良好（P = 0.12）。
解读
在紧急情况下，为埃博拉病毒病患者实施高级支持性护理是可行的。PREDS是一种简单、准确的工具，在外部验证后可帮助为高危患者确定早期高级护理方向。
资金
本研究由国际医疗行动组织（ALIMA）资助。
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