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. 2016 Jan:42:34-39.
doi: 10.1016/j.ijid.2015.10.021. Epub 2015 Oct 30.

Age and Ebola viral load correlate with mortality and survival time in 288 Ebola virus disease patients

Jin Li  1 , Hui-Juan Duan  1 , Hao-Yang Chen  1 , Ying-Jie Ji  1 , Xin Zhang  1 , Yi-Hui Rong  1 , Zhe Xu  1 , Li-Jian Sun  1 , Ji-Yuan Zhang  1 , Li-Ming Liu  1 , Bo Jin  1 , Jian Zhang  1 , Ning Du  1 , Hai-Bin Su  1 , Guang-Ju Teng  1 , Yue Yuan  1 , En-Qiang Qin  1 , Hong-Jun Jia  1 , Shu Wang  1 , Tong-Sheng Guo  1 , Ye Wang  1 , Jin-Song Mu  1 , Tao Yan  1 , Zhi-Wei Li  1 , Zheng Dong  1 , Wei-Min Nie  1 , Tian-Jun Jiang  1 , Chen Li  1 , Xu-Dong Gao  1 , Dong Ji  1 , Ying-Jie Zhuang  1 , Lei Li  1 , Li-Fu Wang  1 , Wen-Gang Li  1 , Xue-Zhang Duan  1 , Yin-Ying Lu  1 , Zhi-Qiang Sun  1 , Alex B J Kanu  2 , Sheku M Koroma  2 , Min Zhao  3 , Jun-Sheng Ji  1 , Fu-Sheng Wang  4
Affiliations

Age and Ebola viral load correlate with mortality and survival time in 288 Ebola virus disease patients

Jin Li et al. Int J Infect Dis. 2016 Jan.

Abstract

Background: A Chinese medical team managed Ebola virus disease (EVD) patients in Sierra Leone from October 2014 to March 2015 and attended to 693 suspected patients, of whom 288 had confirmed disease.

Methods: A retrospective study was conducted of the 288 patients with confirmed disease. Clinical symptoms, manifestations, and serum viral load were analyzed and compared among the different groups for mortality and survival time.

Results: Among the 288 confirmed EVD patients (149 male and 139 female, median age 28 years, and median log viral load 6.68), 98 died, 36 recovered, and 154 were lost to follow-up. Common symptoms were fever (77.78%), fatigue (64.93%), abdominal pain (64.58%), headache (62.85%), and diarrhea (61.81%). Compared to patients aged<18 years, those who were older than 40 years had a higher probability of death (odds ratio 2.855, p=0.044). Patients with a viral load of >10(6) copies/ml had a higher case fatality rate than those with <10(6) copies/ml (odds ratio 3.095, p=0.004). Cox regression showed that age, viral load, and the presence of diarrhea correlated with mortality.

Conclusion: Patients with a high viral load, of older age, and with diarrhea had a higher mortality and shorter survival time.

Keywords: Ebola virus disease; Prevention; Treatment.

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Figures

Figure 1
Figure 1
Flow diagram of the diagnosis and treatment of probable and confirmed patients with Ebola virus infection. 693 probable patients were admitted to our hospital. 288 patients were confirmed to have Ebola Virus Disease (EVD) by monitoring serum viral nucleotide acids. 134 of 288 cases had clear records: 98 of them died from EVD (45 male and 53 female cases) and 36 cases were cured. The remaining 154 cases were transferred to other Ebola treatment center and were lost to follow-up. Therefore, our study mainly focused on the analysis of the detailed data of the 134 cases with good records.
Figure 2
Figure 2
Distribution of patient age was not normally distributed: the majority of the patients were aged 15–35-years old.
Figure 4
Figure 4
Survival curves according to age. Kaplan-Meier Estimate of the probability of survival showed that older patients had shorter survival times (Log-rank (Mantel-Cox) p = 0.009. Dash line and cross represent patients ≤18-years-old, long peck line and diamond represent patients of 18–40- years-old, dot line and round represent patients >40-years-old.
Figure 3
Figure 3
Presentation rates of different symptoms. Patients who died tended to have most symptoms more frequently, except skin rash, coma and pain the behind eyes than those who survived. The differences in the rates of diarrhea, fatigue and difficult swallowing were significant.
Figure 5
Figure 5
Survival curves according to viral load. Kaplan-Meier estimate of the probability of survival showed that patients who presented with higher viral load had shorter survival times (Log-rank (Mantel-Cox) p = 0.000. Solid line and diamond represent patients had £ 1,000,000 EBOV copies per milliliter of plasma (log of virus load £ 6), dot line and cross represent patients presented with more than 1,000,000 EBOV copies per milliliter (log of virus load >6).
Figure 6
Figure 6
Survival curves at the mean of covariate showed that most of the deceased patients died in the first 8 days.
See this image and copyright information in PMC

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