Blood kinetics of Ebola virus in survivors and nonsurvivors
Simone Lanini, … , Giuseppe Ippolito, INMI-EMERGENCY EBOV Sierra Leone Study group
Simone Lanini, … , Giuseppe Ippolito, INMI-EMERGENCY EBOV Sierra Leone Study group
Published December 1, 2015; First published November 9, 2015
Citation Information: J Clin Invest. 2015;125(12):4692-4698. https://doi.org/10.1172/JCI83111.
View: Text | PDF
Categories: Clinical Medicine Infectious disease Microbiology

Blood kinetics of Ebola virus in survivors and nonsurvivors

Abstract

BACKGROUND. Infection with Ebola virus (EBOV) results in a life-threatening disease, with reported mortality rates between 50%–70%. The factors that determine patient survival are poorly understood; however, clinical observations indicate that EBOV viremia may be associated with fatal outcome. We conducted a study of the kinetics of Zaire EBOV viremia in patients with EBOV disease (EVD) who were managed at an Ebola Treatment Centre in Sierra Leone during the recent West African outbreak.

METHODS. Data from 84 EVD patients (38 survivors, 46 nonsurvivors) were analyzed, and EBOV viremia was quantified between 2 and 13 days after symptom onset. Time since symptom onset and clinical outcome were used as independent variables to compare EBOV viral kinetics in survivors and nonsurvivors.

RESULTS. In all patients, EBOV viremia kinetics was a quadratic function of time; however, EBOV viremia was 0.94 logarithm (log) copies per ml (cp/ml) (P = 0.011) higher in nonsurvivors than in survivors from day 2 after the onset of symptoms. Survivors reached peak viremia levels at an earlier time after symptom onset than nonsurvivors (day 5 versus day 7) and had lower mean peak viremia levels compared with nonsurvivors (7.46 log cp/ml; 95% CI, 7.17–7.76 vs. 8.60 log cp/ml; 95% CI, 8.27–8.93). Before reaching peak values, EBOV viremia similarly increased both in survivors and nonsurvivors; however, the decay of viremia after the peak was much stronger in survivors than in nonsurvivors.

CONCLUSION. Our results demonstrate that plasma concentrations of EBOV are markedly different between survivors and nonsurvivors at very early time points after symptom onset and may be predicative of outcome. Further studies focused on the early phase of the disease will be required to identify the causal and prognostic factors that determine patient outcome.

FUNDING. Italian Ministry of Health; Italian Ministry of Foreign Affairs; EMERGENCY’s private donations; and Royal Engineers for DFID–UK.

Authors

Simone Lanini, Gina Portella, Francesco Vairo, Gary P. Kobinger, Antonio Pesenti, Martin Langer, Soccoh Kabia, Giorgio Brogiato, Jackson Amone, Concetta Castilletti, Rossella Miccio, Alimuddin Zumla, Maria Rosaria Capobianchi, Antonino Di Caro, Gino Strada, Giuseppe Ippolito, INMI-EMERGENCY EBOV Sierra Leone Study group

×

Figure 2

EBOV kinetics.

Options: View larger image (or click on image) Download as PowerPoint
EBOV kinetics. Linear prediction of EBOV RNA blood levels (viremia) acco...
Linear prediction of EBOV RNA blood levels (viremia) according to the time since symptom onset and patients’ clinical outcomes. All estimates were made on the full dataset, including 275 EBOV RNA determinations on the 84 patients. (A) Survivors: 38 patients with 114 EBOV RNA determinations. (B) Nonsurvivors: 46 patients with 161 EBOV RNA determinations. Dots indicate single EBOV RNA determination; black line indicates linear prediction according to linear multilevel model; green dashed line indicates the LOD of the EBOV RNA assay (3.11 log cp/ml).