[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]
J Infect Dis. 2019 Feb 21. pii: jiz078. doi: 10.1093/infdis/jiz078. [Epub ahead of print]
Laboratory findings, compassionate use of favipiravir, and outcome in patients with Ebola virus disease, Guinea, 2015 – a retrospective observational study.
Kerber R1,2,3, Lorenz E1,3, Duraffour S1,2,3, Sissoko D4,5, Rudolf M1,2,3, Jaeger A1,3, Cisse SD6, Camara AM6, Miranda O7, Castro CM7, Akoi Bore J2,6, Raymond Koundouno F2,6, Repits J2,8, Afrough B2,9, Becker-Ziaja B1,2,3, Hinzmann J2,10, Mertens M2,3,11, Vitoriano I2,9, Hugh Logue C2,9, Böttcher JP2,10, Pallasch E1,2,3, Sachse A2,10, Bah A2,12, Cabeza-Cabrerizo M2, Nitzsche K2, Kuisma E2,9, Michel J2,10, Holm T1,2,3, Gayle Zekeng E2, Cowley LA2,13,14, Garcia-Dorival I2,15, Hetzelt N2,10, Josef Baum JH1,2, Portmann J2,16, Carter L2,17,18, Yenamaberhan RL1,2, Camino A2, Enkirch T2,19, Singethan K2,20, Meisel S1,2, Mazzarelli A2,21, Kosgei A2,22, Kafetzopoulou L2,23, Rickett NY2,15, Patrono LV1,2, Ghebreghiorghis L2,10, Arnold U2,10, Colin G4,5,24, Juchet S4,5,24, Marchal CL4, Kolie JS25, Beavogui AH25, Wurr S1,2,3, Bockholt S1,2,3, Krumkamp R1,3, May J1,3, Stoecker K2,3,26, Fleischmann E2,3,26, Ippolito G2,21, W Carroll M2,9,27, Koivogui L28, Magassouba N29, Keita S6, Gurry C18, Drury P18, Diallo B30, Formenty P18, Wölfel R2,3,26, Caro AD2,21, Gabriel M1,2,3, Anglaret X4,5,24, Malvy D4,5, Günther S1,2,3.
Author information: 1 Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany. 2 The European Mobile Laboratory Consortium, Hamburg, Germany. 3 German Centre for Infection Research (DZIF), Germany. 4 INSERM U1219, Bordeaux University, Bordeaux, France. 5 Bordeaux University Hospital, Bordeaux, France. 6 Ministry of Health Guinea, Conakry, Guinea. 7 Hospital Militar Central Dr. Carlos J. Finlay, Havana, Cuba. 8 Janssen-Cilag, Sollentuna, Sweden. 9 Public Health England, Porton Down, Salisbury, United Kingdom. 10 Robert Koch Institute, Berlin, Germany. 11 Friedrich Loeffler Institute, Federal Research Institute for Animal Health, Greifswald, Insel Riems, Germany. 12 Swiss Tropical and Public Health Institute, Basel, Switzerland. 13 Public Health England, London, United Kingdom. 14 The Milner Centre for Evolution, University of Bath, Bath, United Kingdom. 15 Institute of Infection and Global Health, University of Liverpool, Liverpool, United Kingdom. 16 Federal Office for Civil Protection, Spiez Laboratory, Spiez, Switzerlands. 17 University College London, London, United Kingdom. 18 World Health Organization, Geneva, Switzerland. 19 Paul-Ehrlich-Institut, Division of Veterinary Medicine, Langen, Germany. 20 Institute of Virology, Technische Universität München, Munich, Germany. 21 National Institute for Infectious Diseases “Lazzaro Spallanzani” IRCCS, Rome, Italy. 22 Kenya Medical Research Institute, Nairobi, Kenya. 23 KU Leuven – University of Leuven, Rega Institute for Medical Research, Leuven, Belgium. 24 PAC-CI, ANRS Research Site, Treichville University Hospital, Abidjan, Côte d’Ivoire. 25 Centre de Recherche en Santé Rurale, Maférinya, Guinea. 26 Bundeswehr Institute of Microbiology, Munich, Germany. 27 University of Southampton, South General Hospital, Southampton, United Kingdom. 28 Institut National de Santé Publique, Conakry, Guinea. 29 Université Gamal Abdel Nasser de Conakry, Laboratoire des Fièvres Hémorragiques en Guinée, Conakry, Guinea. 30 World Health Organization, Conakry, Guinea.
In 2015, the laboratory at the Ebola treatment center in Coyah, Guinea, confirmed Ebola virus disease (EVD) in 286 patients. Cycle threshold (Ct) in the Ebola virus RT-PCR and 13 blood chemistry parameters were measured on admission and during hospitalization. Favipiravir treatment was offered to EVD patients on compassionate use basis.
To reduce biases in the raw field data, we carefully selected 163 of the 286 EVD patients for a retrospective study to assess associations between potential risk factors, alterations in blood chemistry, favipiravir treatment, and outcome.
The case fatality rate in favipiravir-treated patients was lower than in untreated patients (31/73 [42.5%] vs. 52/90 [57.8%], p = 0.053 in univariate analysis). In the multivariate regression analysis, higher Ct value and younger age were associated with survival (p <0.001), while favipiravir treatment showed no statistically significant effect (p = 0.11). However, Kaplan-Meier analysis indicated a longer survival time in the favipiravir-treated group (p = 0.015). The study also showed characteristic changes in blood chemistry in fatal cases vs. survivors.
Consistent with the JIKI trial, this retrospective study reveals a trend toward improved survival in favipiravir-treated patients; however, the effect was not statistically significant except for survival time.
© The Author(s) 2019. Published by Oxford University Press for the Infectious Diseases Society of America.
KEYWORDS: Ebola virus disease; Epidemic; Favipiravir; Filovirus; Guinea; Mobile laboratory
PMID: 30788508 DOI: 10.1093/infdis/jiz078
Keywords: Ebola; Ebola-Makona; Guinea; Antivirals; Favipiravir.