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Potential biomarkers of death identified in Ebola hemorrhagic fever
Recent data published in the Journal of Infectious Diseases identified certain chemokines and cytokines that were associated with death, hemorrhage and viremia related to Ebola hemorrhagic fever.
Researchers from the Viral Special Pathogens Branch of the CDC evaluated serum samples from patients affected by Sudan virus-associated Ebola hemorrhagic fever during an outbreak in 2000-2001. The outbreak, which occurred in the Gulu district of Uganda, was the largest outbreak on record, causing 425 cases of Ebola hemorrhagic fever, of which 216 were laboratory-confirmed.
The study included 86 patients from this outbreak, and 36% of these patients had hemorrhagic manifestations. Half of the patients died. The researchers assessed 55 different biomarkers in 187 serum samples. Thirty-six patients had two or more samples available.
In serum chemistry tests, the researchers confirmed previous data that suggested higher levels of viremia were associated with fatal outcome. They also confirmed that higher levels of aspartate aminotransferase, blood urea nitrogen and creatinine levels were associated with increased fatality, as were lower levels of albumin.
They analyzed 25 different cytokines and chemokines, and found that elevated levels of the following were associated with fatal outcome: interleukin (IL)-1 alpha, IL-1, IL-1 receptor antagonist, IL-6, monocyte chemoattractant protein-1 (MCP-1), macrophage colony-stimulating factor (MCSF) and macrophage inflammatory protein (MIP)-1–alpha. Among patients who develop hemorrhagic manifestations, MCSF, MIP-1–alpha and inducible protein-10 were elevated.
“We also found several novel associations, most strikingly, the association between increased [soluble CD40 ligand] levels and non-fatal outcomes,” the researchers wrote. “Since sCD40L is largely produced by activated platelets, increased [soluble CD40 ligand] levels could represent ongoing repair of altered endothelium by activated platelets.”
Disclosure: The researchers report no relevant financial disclosures.