314 Treatment With Intravenous Fluid Therapy Was Not Associated With Improved Survival Among Patients With Ebola Virus Disease: An International Multisite Cohort Study

Abstract

To evaluate the association between crystalloid intravenous fluid (IVF) therapies and mortality outcomes among patients with Ebola Virus Disease (EVD). This retrospective cohort study accrued patients with EVD admitted to 5 International Medical Corps run Ebola Treatment Units (ETU) in 2 countries during the 2013-16 epidemic. Standardized treatments with antimicrobials and nutritional supplementation were provided to all patients, however IVF was administered based on clinical indication and resource availability. The outcome of interest was 28-day survival compared between cases exposed to IVF therapies and those not. To control for patient and epidemic specific time varying factors cases were temporally reweighted on their viral load at triage and clinical symptoms based on each day of treatment using inverse probability weighting adjustments for receipt of IVF therapies. Bootstrap sampling techniques were used to derive 95% confidence intervals (CI) and assess for significance between comparison groups. There were 424 cases analyzed, of which 354 (83.5%) received treatments with IVF therapies. The mean age was 30.5 years and 57.0% were female. The most common case symptoms included diarrhea (86%), anorexia (81%), vomiting (77%), fever (77%), and dysphasia (59%). Cases treated with IVF therapies were found to have no significant difference in proportional survival as compared to those not treated with IVF therapies at 0.31 (95% CI: 0.21-0.48) versus 0.38 (95% CI: 0.25-0.64), respectively (p=0.367). Among cases suffering mortality within 28-days mean survival durations were 5.5 (95% CI: 4.8-6.5) days among those who received IVF therapies and 5.7 (95% CI: 5.1-6.7) days for those not treated with IVF therapies (p=0.257). Although mortality was greater among cases that received IVF there were no significant differences in survival outcomes, suggesting minimal utility for a therapy requiring relatively high-resource allocation and greater provider risk in epidemic settings.