Abstract
IntroductionPrevious studies of Ebola Virus Disease (EVD) have focused on clinical symptoms and Ebola virus (EBOV) cycle threshold (CT) values recorded at patient triage. Our study explores EVD symptoms and EBOV CT values from onset of illness to recovery or death in a diverse population of patients.Methodology/Principal findingsWe analyzed clinical care data from EBOV positive patients admitted to five Ebola treatment units in West Africa from 2014–2015. Prevalence of clinical signs/symptoms and CT values were explored using descriptive statistics. Logistic regression was used to examine their association with mortality. Survival was analyzed using Kaplan-Meier estimators from symptom onset date to death. During the first week of illness, dyspnea (OR = 2.44, 95% CI: 1.07–5.85) and tachycardia (OR = 10.22, 95% CI: 2.20–56.71) were associated with higher odds of mortality. Dyspnea (OR = 2.33, 95% CI: 1.210–4.581), bleeding (OR = 2.51, 95% CI: 1.219–5.337), and diarrhoea (OR = 2.79, 95% CI: 1.171–6.970) at any point during the illness course were associated with higher odds of mortality. Higher initial (OR = 0.85, 95% CI: 0.81–0.89) and mean (OR = 0.60, 95% CI: 0.53–0.66) CT values were associated with lower odds of mortality. CT values reached their nadir after 3–5 days of illness and then rose in both survivors and non-survivors until recovery or death.Conclusions/SignificanceOur study demonstrates the population prevalence of clinical signs/symptoms and EBOV CT values over time in a large, diverse cohort of patients with EVD, as well as associations between symptoms/EBOV CT values and mortality. These findings have implications on surveillance, operational planning, and clinical care for future EVD outbreaks.
Highlights
Our study demonstrates the population prevalence of clinical signs/symptoms and Ebola virus (EBOV) cycle threshold (CT) values over time in a large, diverse cohort of patients with Ebola Virus Disease (EVD), as well as associations between symptoms/EBOV CT values and mortality
Using data collected as part of clinical care at five Ebola Treatment Units (ETUs) across Liberia and Sierra Leone over the course of a full year, this study aims to expand our understanding of the natural history of EVD from symptom onset to recovery or death, which can lead to improved surveillance and clinical management during future outbreaks
This study is the first to describe the population prevalence of clinical signs/symptoms and CT values on each day of illness in a large cohort of patients infected with EVD who were managed in different countries at varying phases of the epidemic
Summary
Using data collected as part of clinical care at five Ebola Treatment Units (ETUs) across Liberia and Sierra Leone over the course of a full year, this study aims to expand our understanding of the natural history of EVD from symptom onset to recovery or death, which can lead to improved surveillance and clinical management during future outbreaks
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