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. 2020 Mar;10(1):23-29.
doi: 10.1016/j.afjem.2019.11.001. Epub 2020 Jan 3.

Association between multivitamin supplementation and mortality among patients with Ebola virus disease: An international multisite cohort study

Derrick Yam  1 , Adam R Aluisio  2 , Shiromi M Perera  3 , Jillian L Peters  4 , Daniel K Cho  4 , Stephen B Kennedy  5 , Moses Massaquoi  5 , Foday Sahr  6 , Michael A Smit  7 , Lindsey Locks  8 , Tao Liu  1 , Adam C Levine  2
Affiliations

Association between multivitamin supplementation and mortality among patients with Ebola virus disease: An international multisite cohort study

Derrick Yam et al. Afr J Emerg Med. 2020 Mar.

Abstract

Introduction: Micronutrient supplementation is recommended in Ebola Virus Disease (EVD) care; however, there is limited data on its therapeutic effects.

Methods: This retrospective cohort study included patients with EVD admitted to five Ebola Treatment Units (ETU) in Sierra Leone and Liberia during September 2014 to December 2015. A uniform protocol was used to guide ETU care, however, due to supply limitations, only a subset of patients received multivitamins. Data on demographics, clinical characteristics, and laboratory testing was collected. The outcome of interest was facility-based mortality and the primary predictor was multivitamin supplementation initiated within 48 h of admission. The multivitamin formulations included: thiamine, riboflavin, niacin and vitamins A, C, and D3. Propensity score models (PSM) were used to match patients based on covariates associated with multivitamin administration and mortality. Mortality between cases treated and untreated within 48 h of admission were compared using generalized estimating equations to calculate relative risk with bootstrap methods employed to assess statistical significance.

Results: There were 424 patients with EVD who had sufficient treatment data for analysis, of which 261 (61.6%) had daily multivitamins initiated within 48 h of admission. The mean age of the cohort was 30.5 years and 59.4% were female. In the propensity score matched analysis, mortality was 53.5% among patients receiving multivitamins and 66.2% among patients not receiving multivitamins, resulting in a relative risk for mortality of 0.81 (p = 0.03) for patients receiving multivitamins.

Conclusion: Early multivitamin supplementation was associated with lower overall mortality. Further research on the impact of micronutrient supplementation in EVD is warranted.

Keywords: Ebola virus disease; Liberia; Mortality; Multivitamins; Nutrition; Sierra Leone.

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Conflict of interest statement

The authors declare no conflict of interest. All authors had full access to all study data and had final responsibility for the decision to submit for publication. The content of this manuscript is solely the responsibility of the authors and does not necessarily represent the views of International Medical Corps or any governmental bodies or academic organizations. This work was supported by the National Institutes of Health (NIH) National Institute of Allergy and Infectious Diseases [grant number R03AI132801]. The funding source had no involvement in the design or conduct of the study or the decision to submit for publication.

Figures

Fig. 1
Fig. 1
Study population.
Fig. 2
Fig. 2
Multivitamin treatment initiation and duration times stratified by outcome.
Fig. 3
Fig. 3
Covariate balance among predictors before and after propensity score matching.
See this image and copyright information in PMC

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