Dysglycaemia in Ebola virus disease: a retrospective analysis from the 2018 to 2020 outbreakResearch in context
Kasereka Masumbuko Claude,
Daniel Mukadi-Bamuleka,
Kitenge-Omasumbu Richard,
Katsuva Mbahweka Francois,
Paluku Mwalitsa Jean Paul,
Kavugho Muliwavyo,
François Edidi-Atani,
Meris Matondo Kuamfumu,
Sabue Mulangu,
Olivier Tshiani-Mbaya,
Placide Mbala-Kingebeni,
Steve Ahuka-Mundeke,
Jean-Jacques Muyembe-Tamfum,
Bonita E. Lee,
Stan Houston,
Zubia Mumtaz,
Michael T. Hawkes
Affiliations
Kasereka Masumbuko Claude
School of Medicine, Université Catholique du Graben, Butembo, Democratic Republic of the Congo; School of Public Health, University of Alberta, Edmonton, AB, Canada
Daniel Mukadi-Bamuleka
Institut National de Recherche Biomédicale (INRB), Kinshasa, Democratic Republic of the Congo; Service of Microbiology, Department of Medical Biology, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
Kitenge-Omasumbu Richard
National Emergency and Humanitarian Action Program (PNUAH) and Emergency Medical Team (EMT), Ministry of Health of the Democratic Republic of the Congo, Kinshasa, Democratic Republic of the Congo
Katsuva Mbahweka Francois
School of Medicine, Université Catholique du Graben, Butembo, Democratic Republic of the Congo
Paluku Mwalitsa Jean Paul
School of Medicine, Université Catholique du Graben, Butembo, Democratic Republic of the Congo
Kavugho Muliwavyo
School of Medicine, Université Catholique du Graben, Butembo, Democratic Republic of the Congo
François Edidi-Atani
Institut National de Recherche Biomédicale (INRB), Kinshasa, Democratic Republic of the Congo; Service of Microbiology, Department of Medical Biology, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
Meris Matondo Kuamfumu
Institut National de Recherche Biomédicale (INRB), Kinshasa, Democratic Republic of the Congo; Service of Microbiology, Department of Medical Biology, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
Sabue Mulangu
Institut National de Recherche Biomédicale (INRB), Kinshasa, Democratic Republic of the Congo; Service of Microbiology, Department of Medical Biology, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
Olivier Tshiani-Mbaya
Institut National de Recherche Biomédicale (INRB), Kinshasa, Democratic Republic of the Congo; Service of Microbiology, Department of Medical Biology, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
Placide Mbala-Kingebeni
Institut National de Recherche Biomédicale (INRB), Kinshasa, Democratic Republic of the Congo; Service of Microbiology, Department of Medical Biology, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
Steve Ahuka-Mundeke
Institut National de Recherche Biomédicale (INRB), Kinshasa, Democratic Republic of the Congo; Service of Microbiology, Department of Medical Biology, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
Jean-Jacques Muyembe-Tamfum
Institut National de Recherche Biomédicale (INRB), Kinshasa, Democratic Republic of the Congo; Service of Microbiology, Department of Medical Biology, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
Bonita E. Lee
Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
Stan Houston
School of Public Health, University of Alberta, Edmonton, AB, Canada
Zubia Mumtaz
School of Public Health, University of Alberta, Edmonton, AB, Canada
Michael T. Hawkes
School of Public Health, University of Alberta, Edmonton, AB, Canada; Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada; Corresponding author. Department of Pediatrics, University of British Columbia, A5-179, 950 West 28th Ave, Vancouver, BC, V5Z 4H4, Canada.
Summary: Background: Ebola virus disease (EVD) is associated with multisystem organ failure and high mortality. Severe hypoglycaemia is common, life-threatening, and correctable in critically ill patients, but glucose monitoring may be limited in EVD treatment units. Methods: We conducted a retrospective review of patients admitted to EVD treatment units in Butembo and Katwa, Eastern DRC. Glucose measurements were done using a handheld glucometer at the bedside or using the Piccolo xpress Chemistry Analyzer on venous samples. Findings: 384 patients (median age 30 years (interquartile range, IQR, 20–45), 57% female) and 6422 glucose measurements (median 11 per patient, IQR 4–22) were included in the analysis. Severe hypoglycaemia (≤2.2 mmol/L) and hyperglycaemia (>10 mmol/L) were recorded at least once during the ETU admission in 97 (25%) and 225 (59%) patients, respectively. A total of 2004 infusions of glucose-containing intravenous solutions were administered to 302 patients (79%) with a median cumulative dose of 175g (IQR 100–411). The overall case fatality rate was 157/384 (41%) and was 2.2-fold higher (95% CI 1.3–3.8) in patients with severe hypoglycaemia than those without hypoglycaemia (p = 0.0042). In a multivariable Cox proportional hazards model, periods of severe hypoglycaemia (adjusted hazard ratio (aHR) 6.2, 95% CI 3.2–12, p < 0.0001) and moderate hypoglycaemia (aHR 3.0, 95% CI 1.9–4.8, p < 0.0001) were associated with elevated mortality. Interpretation: Hypoglycaemia is common in EVD, requires repeated correction with intravenous dextrose solutions, and is associated with mortality. Funding: This study was not supported by any specific funding.
