EClinicalMedicine (Dec 2022)

Development of the PREDS score to predict in-hospital mortality of patients with Ebola virus disease under advanced supportive care: Results from the EVISTA cohort in the Democratic Republic of the Congo

  • Marie Jaspard,
  • Sabue Mulangu,
  • Sylvain Juchet,
  • Beatrice Serra,
  • Ibrahim Dicko,
  • Hans-Joeg Lang,
  • Baweye Mayoum Baka,
  • Gaston Musemakweli Komanda,
  • Jeremie Muhindo Katsavara,
  • Patricia Kabuni,
  • Fabrice Mbika Mambu,
  • Margaux Isnard,
  • Christophe Vanhecke,
  • Alexia Letord,
  • Ibrahima Dieye,
  • Oscar Patterson-Lomba,
  • Olivier Tshiani Mbaya,
  • Fiston Isekusu,
  • Donatien Mangala,
  • Jean Luc Biampata,
  • Richard Kitenge,
  • Moumouni Kinda,
  • Xavier Anglaret,
  • Jean Jacques Muyembe,
  • Richard Kojan,
  • Khaled Ezzedine,
  • Denis Malvy

Journal volume & issue
Vol. 54
p. 101699

Abstract

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Summary: Background: As mortality remains high for patients with Ebola virus disease (EVD) despite new treatment options, the ability to level up the provided supportive care and to predict the risk of death is of major importance. This analysis of the EVISTA cohort aims to describe advanced supportive care provided to EVD patients in the Democratic Republic of the Congo (DRC) and to develop a simple risk score for predicting in-hospital death, called PREDS. Methods: In this prospective cohort (NCT04815175), patients were recruited during the 10th EVD outbreak in the DRC across three Ebola Treatment Centers (ETCs). Demographic, clinical, biological, virological and treatment data were collected. We evaluated factors known to affect the risk of in-hospital death and applied univariate and multivariate Cox proportional-hazards analyses to derive the risk score in a training dataset. We validated the score in an internal-validation dataset, applying C-statistics as a measure of discrimination. Findings: Between August 1st 2018 and December 31th 2019, 711 patients were enrolled in the study. Regarding supportive care, patients received vasopressive drug (n = 111), blood transfusion (n = 101), oxygen therapy (n = 250) and cardio-pulmonary ultrasound (n = 15). Overall, 323 (45%) patients died before day 28. Six independent prognostic factors were identified (ALT, creatinine, modified NEWS2 score, viral load, age and symptom duration). The final score range from 0 to 13 points, with a good concordance (C = 86.24%) and calibration with the Hosmer-Lemeshow test (p = 0.12). Interpretation: The implementation of advanced supportive care is possible for EVD patients in emergency settings. PREDS is a simple, accurate tool that could help in orienting early advanced care for at-risk patients after external validation. Funding: This study was funded by ALIMA.

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