Acute kidney injury, electrolyte abnormalities common among Ebola cases
Recently published data from an Ebola treatment center revealed a high prevalence of hematological and biochemical abnormalities among patients with at least a mild case of Ebola virus disease.
Researchers assessed laboratory and clinical data, including clinical presentation and hematological and biochemical analysis, from all patients with Ebola virus disease (EVD) admitted to the Kerry Town Ebola treatment center in Sierra Leone from December 2014 to January. EVD was confirmed using reverse-transcriptase PCR.
Among 118 assessed patients in the study, 35% died. Sixty-one percent of patients presented with stage 2 disease (gastrointestinal involvement) and 10% presented with stage 3 disease (severe or complicated).
Researchers reported severe hepatitis in 59% of patients, acute kidney injury (50%), abnormal serum potassium (33%) and increased C-reactive protein (21%). Hematological abnormalities also were common, including thrombocytopenia (45%), granulocytosis (42%) and elevated hematocrit (15%).
Acute kidney injury was more common in fatal than nonfatal cases and was always severe. The incidence rate of acute kidney injury, however, did not differ by disease stage.
“Our results show that Ebola virus disease-associated acute kidney injury can be managed successfully in this setting,” the researchers wrote.
Analyses revealed that severe acute kidney injury, an RT-PCR cycle threshold of less than 20 cycles and severe hepatitis were independently associated with mortality. Disease stage at admission was not associated with mortality after adjustment for other factors.
“The high prevalence of electrolyte abnormalities and acute kidney injury reinforce the role of individual biochemistry measurement, targeted electrolyte support and aggressive maintenance of volume status, which is achievable within the Ebola treatment clinic context following recent advances in portable laboratory analytics,” the researchers wrote. “Expert consensus would suggest this enhanced care is likely to improve case fatality rates as in other acute critical illnesses, and this should become standard practice for Ebola virus disease case management.”
Specifically, the researchers suggested clinical care should target hypovolemia, electrolyte disturbance and acute kidney injury. – by Tina DiMarcantonio
Disclosure: The researchers report no relevant financial disclosures.