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2018 ; 98
(4
): 1186-1193
Nephropedia Template TP
gab.com Text
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English Wikipedia
Clinical Manifestations and Modes of Death among Patients with Ebola Virus
Disease, Monrovia, Liberia, 2014
#MMPMID29405115
Mobula LM
; Nathalie MacDermott
; Clive Hoggart
; Brantly K
; Plyler W
; Brown J
; Kauffeldt B
; Eisenhut D
; Cooper LA
; Fankhauser J
Am J Trop Med Hyg
2018[Apr]; 98
(4
): 1186-1193
PMID29405115
show ga
Although the high case fatality rate (CFR) associated with Ebola virus disease
(EVD) is well documented, there are limited data on the actual modes of death. We
conducted a retrospective, observational cohort study among patients with
laboratory-confirmed EVD. The patients were all seen at the Eternal Love Winning
Africa Ebola Treatment Unit in Monrovia, Liberia, from June to August 2014. Our
primary objective was to describe the modes of death of our patients and to
determine predictors of mortality. Data were available for 53 patients with
laboratory-confirmed EVD, with a median age of 35 years. The most frequent
presenting symptoms were weakness (91%), fever (81%), and diarrhea (78%). Visible
hemorrhage was noted in 25% of the cases. The CFR was 79%. Odds of death were
higher in patients with diarrhea (odds ratio = 26.1, P < 0.01). All patients with
hemorrhagic signs died (P < 0.01). Among the 18 fatal cases for which clinical
information was available, three distinct modes of death were observed: sudden
death after a moderate disease process (44%), profuse hemorrhage (33%), and
encephalopathy (22%). We found that these modes of death varied by age (P =
0.04), maximum temperature (P = 0.43), heart rate on admission (P = 0.04), time
to death from symptom onset (P = 0.13), and duration of hospitalization (P =
0.04). Although further study is required, our findings provide a foundation for
developing treatment strategies that factor in patients with specific disease
phenotypes (which often require the use of aggressive hydration). These findings
provide insights into underlying pathogenic mechanisms resulting in severe EVD
and suggest direction for future research and development of effective treatment
options.