Association of clinical signs and symptoms of Ebola viral disease with case fatality

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This meta-analysis assesses the utility of clinical signs, symptoms, and laboratory data in predicting mortality in Ebola virus disease (EVD). Sixty-seven articles covering EVD with more than 35 cases were used in identifying bleeding events, vomiting, diarrhea, abdominal pain, cough, sore throat and conjunctivitis.

Information from articles across multiple outbreaks has been used to support the triage of EVD patients based on clinical features and laboratory values, in the hope of improving prognosis. All included articles are observational studies, as there were no randomized controlled trials. Symptoms and signs noted above were more often present in the pooled proportion of fatal cases compared to the pooled proportion of EVD survivors. Meaningful association of fevers, fatigue, headache, dyspnea, arthralgia, myalgia, elevated aspartame transaminase (AST), alanine transaminase (ALT), blood urea nitrogen (BUN), and creatinine could not be made with case fatality. Symptoms varied between the different outbreaks.

Analysis was hampered because detailed clinical data was only available in about 50-60% of the total patient population; presentation in African outbreaks may be, on average, later after symptoms appear than in the West.

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