A study of Ebola patients that assessed lab values for electrolytes and other body chemistry-type tests found a strong association between the deadly virus and hematological and biochemical abnormalities. Researchers and clinicians already knew that Ebola virus disease causes substantial organ dysfunction, particularly of the renal and hepatic systems. However, this study is the first to report Ebola infection-related hematological parameters and independent risk factors for mortality, according to the authors.
Independent risk factors for Ebola-related mortality include severe acute kidney injury (AKI), severe hepatitis, and low RT-PCR cycle threshold (<20 cycles). Results were published in The Lancet Infectious Diseases journal. The study provides the largest and most complete dataset of lab parameters in Ebola virus disease, according to the authors.
The Ebola outbreak in West Africa has reached approximately 27,500 cases. The virus, which in most instances causes fever, diarrhea, vomiting, and, in some cases, hemorrhaging, has been difficult to manage in affected areas. A proven treatment is currently out of reach.
“Ebola virus disease causes marked biochemical abnormalities, which might be amenable to simple interventions, potentially reducing the high case fatality rate,” the researchers wrote. To gain new insight into Ebola’s pathophysiology, they decided to report on clinical presentation, lab abnormalities and association with mortality in 150 patients admitted to a treatment center in Sierra Leone over the course of a month. The study eventually narrowed the patient cohort to 118. Researchers conducted analyses on hematology and biochemistry parameters for 104 and 114 of these patients, respectively.
Most patients were in the second or third stage of disease. A number of conditions, such as AKI, abnormal serum potassium, raised C-reactive protein, and severe hepatitis, were commonly found in this population.
Overall, the researchers found most patients had a “marked electrolyte imbalance in all stages of Ebola virus disease.” Patients also commonly had hematological derangements, including thrombocytopenia, lymphocytosis, and raised hematocrit levels. A majority of the patients had raised concentrations of alanine transaminase or aspartate transaminase, conditions associated with mortality.
To reduce high death rates among Ebola patients, the investigators suggested that clinical care place a special focus on hypovolemia, electrolyte disturbance, and AKI.
Commenting on the study’s findings in the Lancet, authors John Schieffelin and Shevin T. Jacob found it noteworthy that AKI was so prevalent among the Ebola patients, even those who never presented with multi-organ dysfunction or gastrointestinal problems. This is one area that deserves further study, they suggested.
“Additionally, 33% of all patients had abnormal potassium concentrations. However, just as many patients had hyperkalaemia as hypokalaemia, suggesting that electrolyte replacement in patients with Ebola should not be approached with a one-size-fits-all algorithm and the ability to monitor electrolytes and other laboratory tests is crucial to being able to provide safe and effective care of all patients with Ebola in an Ebola treatment centre,” wrote Schieffelin and Jacob.