Association between oral antimalarial medication administration and mortality among patients with Ebola virus disease: a multisite cohort study

BACKGROUND: Empiric antimalarial treatment is a component of protocol-based management of Ebola virus disease (EVD), yet this approach has limited clinical evidence for patient-centered benefits. METHODS: This retrospective cohort study evaluated the association between antimalarial treatment and mo...

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Autores principales: Abel, Logan, Perera, Shiromi M., Yam, Derrick, Garbern, Stephanie, Kennedy, Stephen B., Massaquoi, Moses, Sahr, Foday, Woldemichael, Dayan, Liu, Tao, Levine, Adam C., Aluisio, Adam R.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8772178/
https://www.ncbi.nlm.nih.gov/pubmed/35057753
http://dx.doi.org/10.1186/s12879-021-06811-3
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author Abel, Logan
Perera, Shiromi M.
Yam, Derrick
Garbern, Stephanie
Kennedy, Stephen B.
Massaquoi, Moses
Sahr, Foday
Woldemichael, Dayan
Liu, Tao
Levine, Adam C.
Aluisio, Adam R.
author_facet Abel, Logan
Perera, Shiromi M.
Yam, Derrick
Garbern, Stephanie
Kennedy, Stephen B.
Massaquoi, Moses
Sahr, Foday
Woldemichael, Dayan
Liu, Tao
Levine, Adam C.
Aluisio, Adam R.
author_sort Abel, Logan
collection PubMed
description BACKGROUND: Empiric antimalarial treatment is a component of protocol-based management of Ebola virus disease (EVD), yet this approach has limited clinical evidence for patient-centered benefits. METHODS: This retrospective cohort study evaluated the association between antimalarial treatment and mortality among patients with confirmed EVD. The data was collected from five International Medical Corps operated Ebola Treatment Units (ETUs) in Sierra Leone and Liberia from 2014 through 2015. The standardized protocol used for patient care included empiric oral treatment with combination artemether and lumefantrine, twice daily for three days; however, only a subset of patients received treatment due to resource variability. The outcome of interest was mortality, comparing patients treated with oral antimalarials within 48-h of admission to those not treated. Analysis was conducted with logistic regression to generate adjusted odds ratios (aORs). Multivariable analyses controlled for ETU country, malaria rapid diagnostic test result, age, EVD cycle threshold value, symptoms of bleeding, diarrhea, dysphagia and dyspnea, and additional standard clinical treatments. RESULTS: Among the 424 cases analyzed, 376 (88.7%) received early oral antimalarials. Across all cases, mortality occurred in 57.5% (244). In comparing unadjusted mortality prevalence, early antimalarial treated cases yielded 55.1% mortality versus 77.1% mortality for those untreated (p = 0.005). Multivariable analysis demonstrated evidence of reduced aOR for mortality with early oral antimalarial treatment versus non-treatment (aOR = 0.34, 95% Confidence Interval: 0.12, 0.92, p = 0.039). CONCLUSION: Early oral antimalarial treatment in an EVD outbreak was associated with reduced mortality. Further study is warranted to investigate this association between early oral antimalarial treatment and mortality in EVD patients. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12879-021-06811-3.
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spelling pubmed-87721782022-01-20 Association between oral antimalarial medication administration and mortality among patients with Ebola virus disease: a multisite cohort study Abel, Logan Perera, Shiromi M. Yam, Derrick Garbern, Stephanie Kennedy, Stephen B. Massaquoi, Moses Sahr, Foday Woldemichael, Dayan Liu, Tao Levine, Adam C. Aluisio, Adam R. BMC Infect Dis Research BACKGROUND: Empiric antimalarial treatment is a component of protocol-based management of Ebola virus disease (EVD), yet this approach has limited clinical evidence for patient-centered benefits. METHODS: This retrospective cohort study evaluated the association between antimalarial treatment and mortality among patients with confirmed EVD. The data was collected from five International Medical Corps operated Ebola Treatment Units (ETUs) in Sierra Leone and Liberia from 2014 through 2015. The standardized protocol used for patient care included empiric oral treatment with combination artemether and lumefantrine, twice daily for three days; however, only a subset of patients received treatment due to resource variability. The outcome of interest was mortality, comparing patients treated with oral antimalarials within 48-h of admission to those not treated. Analysis was conducted with logistic regression to generate adjusted odds ratios (aORs). Multivariable analyses controlled for ETU country, malaria rapid diagnostic test result, age, EVD cycle threshold value, symptoms of bleeding, diarrhea, dysphagia and dyspnea, and additional standard clinical treatments. RESULTS: Among the 424 cases analyzed, 376 (88.7%) received early oral antimalarials. Across all cases, mortality occurred in 57.5% (244). In comparing unadjusted mortality prevalence, early antimalarial treated cases yielded 55.1% mortality versus 77.1% mortality for those untreated (p = 0.005). Multivariable analysis demonstrated evidence of reduced aOR for mortality with early oral antimalarial treatment versus non-treatment (aOR = 0.34, 95% Confidence Interval: 0.12, 0.92, p = 0.039). CONCLUSION: Early oral antimalarial treatment in an EVD outbreak was associated with reduced mortality. Further study is warranted to investigate this association between early oral antimalarial treatment and mortality in EVD patients. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12879-021-06811-3. BioMed Central 2022-01-20 /pmc/articles/PMC8772178/ /pubmed/35057753 http://dx.doi.org/10.1186/s12879-021-06811-3 Text en © The Author(s) 2022 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research
Abel, Logan
Perera, Shiromi M.
Yam, Derrick
Garbern, Stephanie
Kennedy, Stephen B.
Massaquoi, Moses
Sahr, Foday
Woldemichael, Dayan
Liu, Tao
Levine, Adam C.
Aluisio, Adam R.
Association between oral antimalarial medication administration and mortality among patients with Ebola virus disease: a multisite cohort study
title Association between oral antimalarial medication administration and mortality among patients with Ebola virus disease: a multisite cohort study
title_full Association between oral antimalarial medication administration and mortality among patients with Ebola virus disease: a multisite cohort study
title_fullStr Association between oral antimalarial medication administration and mortality among patients with Ebola virus disease: a multisite cohort study
title_full_unstemmed Association between oral antimalarial medication administration and mortality among patients with Ebola virus disease: a multisite cohort study
title_short Association between oral antimalarial medication administration and mortality among patients with Ebola virus disease: a multisite cohort study
title_sort association between oral antimalarial medication administration and mortality among patients with ebola virus disease: a multisite cohort study
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8772178/
https://www.ncbi.nlm.nih.gov/pubmed/35057753
http://dx.doi.org/10.1186/s12879-021-06811-3
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