Supportive Care Increases Odds of Ebola Survival

Enhancing supportive care improves the chances of a patient surviving an Ebola infection.

By enhancing supportive care, researchers have improved the chances of a patient surviving an Ebola infection, according to the results of a recent study.

Various approaches to treating infected patients are ongoing. Several candidate vaccines are currently undergoing clinical trials, and the first trials involving therapeutic—and potentially curative–whole blood or blood plasma transfusions from recovered patients are set to begin soon.

However, scientists have now found that supportive care, specifically rehydration and treatment of metabolic abnormalities, may increase the chances of a patient surviving the virus. Their study, published November 6, 2014, in the New England Journal of Medicine, evaluated clinical data on 37 Ebola patients admitted for treatment at facilities in Guinea during the first month of the West African outbreak. Of those patients, 14 were heath care workers, while 12 others acquired the virus within a health care setting.

The patients underwent treatment within a range of 3 to 7 days after the onset of their symptoms. One patient who tested negative on an RT-PCR test was later confirmed positive for Ebola antibodies on a separate evaluation, which the researchers said underscores recommendations by the World Health Organization (WHO) for continued testing before a suspected case is deemed negative or a recovered patient is discharged from a treatment facility.

The most commonly reported symptoms were fever (84%), fatigue (65%), diarrhea (62%), vomiting (57%), and a moderately faster than normal heartbeat. An additional 28% of patients developed hiccups during their stay at the hospital, which is a non-specific yet distinctive feature of the virus.

Among those who experienced severe diarrhea, 36 patients received an oral rehydration solution, while intravenous fluid resuscitation was provided to 28 patients. One patient who suffered an acute kidney injury that was most likely caused by significant diarrhea-related dehydration improved after receiving approximately 5 liters of intravenous crystalloid fluids per day for 3 days.

Antibiotics were administered to 37 patients for the treatment of potential bacterial infections associated with gastrointestinal illness.

Even with the supportive care, 43% of the patients died within an average of 5 days after hospitalization. However, this fatality rate was significantly lower than those recorded at other outbreak sites in West Africa during the current epidemic, as well as in previous outbreaks of the Zaire strain of the virus.

A separate study in Sierra Leone involving 106 patients reported a fatality rate of 74%.

“High-quality supportive care is thought to have contributed to the larger number of survivors,” the authors wrote in a press release. “However, 2 limitations compromised the quality of bedside care: staff were too few in number; and the duration of time spent providing care at the bedside was too little, due to dehydration and overheating of clinicians wearing personal protective equipment. These limitations suggest that survival rates, under more favorable hospital conditions, might be even higher.”