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Viral load useful in making Ebola treatment decisions
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PCR cycle threshold values in the first Ebola virus-positive blood sample test could be a predictor of patient survival and may be beneficial for physicians in making treatment decisions or managing patient and family expectations, according to a study published in Emerging Infectious Diseases.
“During the peak of the epidemic, many health care facilities were quickly filled beyond capacity, which often forced clinicians to make difficult decisions about how to triage patients and how to manage patient and family expectations regarding probable outcomes,” Samuel J. Crowe, PhD, from the CDC’s Epidemic Intelligence Service, and colleagues wrote. “Reliable prognostic indicators available at the time of patient admission could help clinicians make these decisions.”
Figure 1. Matthew J. Maenner, PhD (left), Samuel J. Crowe, PhD, and colleagues found evidence that Ct values in the first Ebola virus-positive blood sample test can predict patient survival and help physicians determine the optimal treatment course.
Source: Crowe
Crowe and colleagues assessed the reliability of two readily available indicators — total elapsed time from symptom onset to admission to a health care facility and cycle threshold (Ct) values — as predictors of survival in patients with Ebola virus disease (EVD) in Sierra Leone. The researchers reviewed data on 216 of the 227 patients in Bo District during a 4-month period from Sept. 12, 2014, to Jan. 7, 2015. The primary cohort comprised 151 patients who were alive when Ebola was detected.
Of the patients in the primary cohort, 60% were female. The mean age for those who survived was low- to mid-20s, while the mean age of those who died was low- to mid-30s. More than half (52%) of these patients died.
According to the researchers, time from symptom onset to health care facility admission was not associated with survival; however, survival was “strongly associated” with Ct values in the first blood sample. The study found that 87% of patients with a Ct value of 24 or greater survived. Meanwhile, of those with a Ct value of less than 24, only 22% survived.
“Additional studies are needed to validate these findings and to continue to explore how Ct values can be combined with other biomarkers (29,30) to provide insights into the effectiveness of treatment and prognosis,” Crowe and colleagues wrote.– by Jason Laday
Disclosure: The researchers report no relevant financial disclosures.
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