Surviving Ebola: A historical cohort study of Ebola mortality and survival in Sierra Leone 2014-2015

Kevin Wing, Shefali Oza, Catherine Houlihan, Judith R. Glynn, Sharon Irvine, Clare E. Warrell, Andrew Simpson, Sabah Boufkhed, Alieu Sesay, Lahai Vandi, Sahr Charles Sebba, Pranav Shetty, Rachael Cummings, Francesco Checchi, Catherine R. McGowan

Research output: Contribution to journalReview articlepeer-review

7 Citations (Scopus)

Abstract

Background: While a number of predictors for Ebola mortality have been identified, less is known about post-viral symptoms. The identification of acute-illness predictors for post-viral symptoms could allow the selection of patients for more active follow up in the future, and those in whom early interventions may be beneficial in the long term. Studying predictors of both mortality and post-viral symptoms within a single cohort of patients could also further our understanding of the pathophysiology of survivor sequelae. Methods/Principal findings: We performed a historical cohort study using data collected as part of routine clinical care from an Ebola Treatment Centre (ETC) in Kerry Town, Sierra Leone, in order to identify predictors of mortality and of post-viral symptoms. Variables included as potential predictors were sex, age, date of admission, first recorded viral load at the ETC and symptoms (recorded upon presentation at the ETC). Multivariable logistic regression was used to identify predictors. Of 263 Ebola-confirmed patients admitted between November 2014 and March 2015,151 (57%) survived to ETC discharge. Viral load was the strongest predictor of mortality (adjusted OR comparing high with low viral load: 84.97, 95% CI 30.87-345.94). We did not find evidence that a high viral load predicted post-viral symptoms (ocular: 1.17, 95% CI 0.35-3.97; musculoskeletal: 1.07, 95% CI 0.28-4.08). Ocular post-viral symptoms were more common in females (2.31, 95% CI 0.98-5.43) and in those who had experienced hiccups during the acute phase (4.73, 95% CI 0.90-24.73). Conclusions/Significance: These findings may add epidemiological support to the hypothesis that post-viral symptoms have an immune-mediated aspect and may not only be a consequence of high viral load and disease severity.

Original languageEnglish
Article numbere0209655
JournalPLoS ONE
Volume13
Issue number12
DOIs
Publication statusPublished - Dec 2018

Bibliographical note

Publisher Copyright:
© 2018 Wing et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Copyright:
Copyright 2019 Elsevier B.V., All rights reserved.

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