134 Virus kinetics and biochemical derangements in children with Ebolavirus disease

Abstract

Abstract Primary Subject area Infectious Diseases Background In the second largest outbreak of Ebolavirus disease (EVD) on record (Democratic Republic of Congo, 2018-2020), 3470 cases were confirmed, 29% of them among children under 18 years of age. Objectives To describe virologic and biochemical characteristics of pediatric patients with EVD, and to compare these to a control group of adults with EVD. Design/Methods Retrospective medical record review of children < 16 years old from two treatment centres in North Kivu, DRC. A control group of patients 16-44 years old was included as a reference comparator group. Patient demographics, serial measurements of viral load, serial biochemistry panel, and frequent point-of-care glucose test results were abstracted from the chart record. Funding provided by the Association for Health Innovation in Africa (AFHIA). Results Seventy-three children and 234 adults were included, admitted from April 24 to October 14, 2019. Pediatric patients commonly had electrolyte imbalances (36% hypokalemia, 52% hyperkalemia, and 74% hyponatremia), AKI (51%), elevated liver enzymes (median peak ALT 380 IU/L and AST 570 IU/L), and rhabdomyolysis (48%). Viral load at admission (7.2 versus 6.5 log10copies/mL, p=0.0001), peak viral load (7.5 versus 6.7 log10copies/mL, p<0.0001), and time to clearance of viremia (16 versus 12 days p<0.0001) were significantly different in children. Duration of hospital stay (20 versus 16 days, p<0.0001) was prolonged in children, a direct consequence of slower clearance of viremia. There was no significant difference between groups in other laboratory values. Factors including ALT >525 U/L, viral load (VL) >7.6 log10copies/mL, BUN >7.5 mmol/L, and CRP >100 mg/L were associated with mortality in children, as in adults. In a multivariable logistic regression model, ALT and VL remained statistically significant independent predictors of mortality. Conclusion Pediatric patients with EVD, like adults, experience multi-organ involvement with life-threatening kidney and liver injury, rhabdomyolysis, and electrolyte imbalances. Pediatric patients have significantly higher viral loads throughout the course of EVD than adults.