Intensive Care Med (2015) 41:1504–1505 DOI 10.1007/s00134-015-3912-0
LETTER
intensive care unit septic patients [2]. We aimed to characterize the severity of Ebola patients admitted to our center by calculating the SOFA score on admission. After approval by the local ethics committee, SOFA score was calculated in Ebola-infected patients using the most abnormal values from the first 24 h after admission. Data were collected between January and April 2015. A total of 38 patients were admitted, of whom 22 were infected with Ebola. Results are expressed as mean ± standard deviation. The mean age of confirmed cases was 33 years (±9). Mean viral load expressed as cycle threshold (CT) at Organ failures on admission admission was 21.6 (±3.9). On the 22 in patients with Ebola virus patients, six died (mortality rate of disease 27.3 %). Mean SOFA score at admission was 2.6 (±1.7). SOFA Accepted: 3 June 2015 score at admission was significantly Published online: 2 July 2015 higher in non-survivors than in surÓ Springer-Verlag Berlin Heidelberg and vivors (4.8 ± 1.7 versus 1.7 ± 1, ESICM 2015 P = 0.001). Mean viral load was also higher in non-survivors (CT at 17.7 ± 3.8 versus 23 ± 3.1, P = 0.006). Renal dysfunction was Dear Editor, the most frequent dysfunction on The actual outbreak of Ebola virus admission in non-survivors (Fig. 1). disease (EVD) started in December Relationships between admission 2013 in West Africa, and spread from patients’ conditions and outcome Guinea to Sierra Leone and Liberia. have never been explored during Organ dysfunctions during EVD have EVD, except for age and viral load only been described through case [3]. A study analyzing the WHO case reports managed in high income investigation form data of 3343 countries, and data are still lacking infected patients reported a high [1]. The Sepsis-related Organ Failure mortality rate above 70 %, but Assessment (SOFA) score has been patients’ organ dysfunctions could developed to quantitatively describe not have been scored [4]. In this the degree of organ dysfunction in study, hemorrhage, coma, and Julien Bordes Fre´de´ric Janvier Marc Aletti Thierry de Greslan Nicolas Gagnon Jean Cotte Claire Rousseau Magali Billhot Jean Marie Cournac Ludovic Karkowski Sophie Moroge Sandrine Duron Thierry Carmoi Gilles Cellarier
‘‘difficulty breathing’’ were not commonly reported in patients who died, suggesting that massive fluid loss due to gastrointestinal disorders may be the main factor of worse outcome. Another study reported a lower mortality rate of 43 % [3]. Risk of death was associated with an older age, but this study failed in identifying other factors, mainly because biological data on admission were also limited as no routine clinical laboratory testing was available. Presented data showed that patients were hemodynamically stable on admission and had no respiratory dysfunction (3 % of patients with oxygen therapy). Our results highlighted two main points. The first is that cardiovascular, respiratory, and neurological dysfunctions were not common on admission in Ebola patients, even in non-survivors. The second is the frequency of renal dysfunction. Acute kidney injury during EVD may be promoted by several factors: hypovolemia due to gastrointestinal fluid loss, inflammatory response, viral injury as suggested by histopathological examination of tissues from infected animals showing indications of interstitial nephritis [5]. Larger studies are needed to describe objectively organ dysfunction in Ebola patients and evolution during stay. It may also help to optimize the preparation of treatment facilities according to local available resources for the next outbreaks. Acknowledgments No funding sources to declare.
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Fig. 1 SOFA score in survivors and non-survivors. Bottom and top of the box are the first and third quartiles, and the band inside the box is the median. Diamond minimum/maximum
Conflicts of interest The authors have no 4. WHO Ebola response team (2014) Ebola conflict of interest to declare. virus disease in West Africa—the first 9 months of the epidemic and forward projections. N Engl J Med 371:1481–1495 5. Johnson RF, Dodd LE, Yellayi S, Gu W, Cann JA, Jett C, Bernbaum JG, Ragland References DR, St Claire M, Byrum R et al (2011) Simian hemorrhagic fever virus infection 1. Wolf T, Kann G, Becker S, Stephan C, of rhesus macaques as a model of viral Brodt HR, de Leuw P, Grunewald T, hemorrhagic fever: clinical Vogl T, Kempf VA, Keppler OT et al characterization and risk factors for (2014) Severe Ebola virus disease with severe disease. Virology 421:129–140 vascular leakage and multiorgan failure: treatment of a patient in intensive care. Lancet 385:1428–1435 2. Vincent JL, Moreno R, Takala J, Willatts J. Bordes ()) F. Janvier M. Aletti S, De Mendonca A, Bruining H, Reinhart T. de Greslan N. Gagnon J. Cotte C. Rousseau M. Billhot J. M. Cournac CK, Suter PM, Thijs LG (1996) The L. Karkowski S. Moroge S. Duron SOFA (Sepsis-related Organ Failure T. Carmoi G. Cellarier Assessment) score to describe organ French Military Ebola Virus Disease dysfunction/failure. On behalf of the working group on sepsis-related Treatment Centre, Conakry, Guinea problems of the European Society of e-mail: [email protected] Intensive Care Medicine. Intensive Care Med 22:707–710 J. Bordes F. Janvier J. Cotte 3. Bah EI, Lamah MC, Fletcher T, Jacob G. Cellarier ST, Brett-Major DM, Sall AA, Shindo N, Sainte Anne Military Teaching Hospital, Fischer WA 2nd, Lamontagne F, Saliou Boulevard Sainte Anne, 83800 Toulon, SM et al (2015) Clinical presentation of France patients with Ebola virus disease in Conakry, Guinea. N Engl J Med 372:40–47
N. Gagnon L. Karkowski Legouest Military Teaching Hospital, 27 Avenue de Plantie`res, 50070 Metz, France T. de Greslan M. Billhot T. Carmoi Val De Graˆce Military Teaching Hospital, 74 Boulevard de Port Royal, 75005 Paris, France M. Aletti J. M. Cournac Percy Military Teaching Hospital, 101 Avenue, 92140 Clamart, France C. Rousseau Clermont Tonnerre Military Teaching Hospital, Rue Colonel Fonferrier, 29200 Brest, France S. Moroge Laveran Military Teaching Hospital, 13e`me Arrondissement, 13013 Marseille, France S. Duron French Military Center for Epidemiology and Public Health, 408 Rue Jean Queillau, 13014 Marseille, France
LETTER
intensive care unit septic patients [2]. We aimed to characterize the severity of Ebola patients admitted to our center by calculating the SOFA score on admission. After approval by the local ethics committee, SOFA score was calculated in Ebola-infected patients using the most abnormal values from the first 24 h after admission. Data were collected between January and April 2015. A total of 38 patients were admitted, of whom 22 were infected with Ebola. Results are expressed as mean ± standard deviation. The mean age of confirmed cases was 33 years (±9). Mean viral load expressed as cycle threshold (CT) at Organ failures on admission admission was 21.6 (±3.9). On the 22 in patients with Ebola virus patients, six died (mortality rate of disease 27.3 %). Mean SOFA score at admission was 2.6 (±1.7). SOFA Accepted: 3 June 2015 score at admission was significantly Published online: 2 July 2015 higher in non-survivors than in surÓ Springer-Verlag Berlin Heidelberg and vivors (4.8 ± 1.7 versus 1.7 ± 1, ESICM 2015 P = 0.001). Mean viral load was also higher in non-survivors (CT at 17.7 ± 3.8 versus 23 ± 3.1, P = 0.006). Renal dysfunction was Dear Editor, the most frequent dysfunction on The actual outbreak of Ebola virus admission in non-survivors (Fig. 1). disease (EVD) started in December Relationships between admission 2013 in West Africa, and spread from patients’ conditions and outcome Guinea to Sierra Leone and Liberia. have never been explored during Organ dysfunctions during EVD have EVD, except for age and viral load only been described through case [3]. A study analyzing the WHO case reports managed in high income investigation form data of 3343 countries, and data are still lacking infected patients reported a high [1]. The Sepsis-related Organ Failure mortality rate above 70 %, but Assessment (SOFA) score has been patients’ organ dysfunctions could developed to quantitatively describe not have been scored [4]. In this the degree of organ dysfunction in study, hemorrhage, coma, and Julien Bordes Fre´de´ric Janvier Marc Aletti Thierry de Greslan Nicolas Gagnon Jean Cotte Claire Rousseau Magali Billhot Jean Marie Cournac Ludovic Karkowski Sophie Moroge Sandrine Duron Thierry Carmoi Gilles Cellarier
‘‘difficulty breathing’’ were not commonly reported in patients who died, suggesting that massive fluid loss due to gastrointestinal disorders may be the main factor of worse outcome. Another study reported a lower mortality rate of 43 % [3]. Risk of death was associated with an older age, but this study failed in identifying other factors, mainly because biological data on admission were also limited as no routine clinical laboratory testing was available. Presented data showed that patients were hemodynamically stable on admission and had no respiratory dysfunction (3 % of patients with oxygen therapy). Our results highlighted two main points. The first is that cardiovascular, respiratory, and neurological dysfunctions were not common on admission in Ebola patients, even in non-survivors. The second is the frequency of renal dysfunction. Acute kidney injury during EVD may be promoted by several factors: hypovolemia due to gastrointestinal fluid loss, inflammatory response, viral injury as suggested by histopathological examination of tissues from infected animals showing indications of interstitial nephritis [5]. Larger studies are needed to describe objectively organ dysfunction in Ebola patients and evolution during stay. It may also help to optimize the preparation of treatment facilities according to local available resources for the next outbreaks. Acknowledgments No funding sources to declare.
1505
Fig. 1 SOFA score in survivors and non-survivors. Bottom and top of the box are the first and third quartiles, and the band inside the box is the median. Diamond minimum/maximum
Conflicts of interest The authors have no 4. WHO Ebola response team (2014) Ebola conflict of interest to declare. virus disease in West Africa—the first 9 months of the epidemic and forward projections. N Engl J Med 371:1481–1495 5. Johnson RF, Dodd LE, Yellayi S, Gu W, Cann JA, Jett C, Bernbaum JG, Ragland References DR, St Claire M, Byrum R et al (2011) Simian hemorrhagic fever virus infection 1. Wolf T, Kann G, Becker S, Stephan C, of rhesus macaques as a model of viral Brodt HR, de Leuw P, Grunewald T, hemorrhagic fever: clinical Vogl T, Kempf VA, Keppler OT et al characterization and risk factors for (2014) Severe Ebola virus disease with severe disease. Virology 421:129–140 vascular leakage and multiorgan failure: treatment of a patient in intensive care. Lancet 385:1428–1435 2. Vincent JL, Moreno R, Takala J, Willatts J. Bordes ()) F. Janvier M. Aletti S, De Mendonca A, Bruining H, Reinhart T. de Greslan N. Gagnon J. Cotte C. Rousseau M. Billhot J. M. Cournac CK, Suter PM, Thijs LG (1996) The L. Karkowski S. Moroge S. Duron SOFA (Sepsis-related Organ Failure T. Carmoi G. Cellarier Assessment) score to describe organ French Military Ebola Virus Disease dysfunction/failure. On behalf of the working group on sepsis-related Treatment Centre, Conakry, Guinea problems of the European Society of e-mail: [email protected] Intensive Care Medicine. Intensive Care Med 22:707–710 J. Bordes F. Janvier J. Cotte 3. Bah EI, Lamah MC, Fletcher T, Jacob G. Cellarier ST, Brett-Major DM, Sall AA, Shindo N, Sainte Anne Military Teaching Hospital, Fischer WA 2nd, Lamontagne F, Saliou Boulevard Sainte Anne, 83800 Toulon, SM et al (2015) Clinical presentation of France patients with Ebola virus disease in Conakry, Guinea. N Engl J Med 372:40–47
N. Gagnon L. Karkowski Legouest Military Teaching Hospital, 27 Avenue de Plantie`res, 50070 Metz, France T. de Greslan M. Billhot T. Carmoi Val De Graˆce Military Teaching Hospital, 74 Boulevard de Port Royal, 75005 Paris, France M. Aletti J. M. Cournac Percy Military Teaching Hospital, 101 Avenue, 92140 Clamart, France C. Rousseau Clermont Tonnerre Military Teaching Hospital, Rue Colonel Fonferrier, 29200 Brest, France S. Moroge Laveran Military Teaching Hospital, 13e`me Arrondissement, 13013 Marseille, France S. Duron French Military Center for Epidemiology and Public Health, 408 Rue Jean Queillau, 13014 Marseille, France
