Impact of Intravenous Fluid Therapy on Survival Among Patients With Ebola Virus Disease: An International Multisite Retrospective Cohort Study

• Published in: Clinical infectious diseases Vol. 70; no. 6; pp. 1038 - 1047
• Main Authors: Aluisio, Adam R, Yam, Derrick, Peters, Jillian L, Cho, Daniel K, Perera, Shiromi M, Kennedy, Stephen B, Massaquoi, Moses, Sahr, Foday, Smit, Michael A, Liu, Tao, Levine, Adam C
• Format: Journal Article
• Language: English
• Published: US Oxford University Press 03.03.2020
• Subjects: Africa, Western; and Commentaries; Ebolavirus; Fluid Therapy; Hemorrhagic Fever, Ebola - drug therapy; Humans; Retrospective Studies; Africa, Western; intravenous fluid; marginal structural models; West Africa; survival; Ebola virus disease
• ISSN: 1058-4838; 1537-6591
• DOI: 10.1093/cid/ciz344

Abstract Background Intravenous fluid (IVF) is a frequently recommended intervention in Ebola virus disease (EVD), yet its impact on patient outcomes remains unclear. Methods This retrospective cohort study evaluated patients with EVD admitted to 5 Ebola treatment units (ETUs) in West Africa. The primary outcome was the difference in 28-day survival between cases treated and not treated with IVF. To control for demographic and clinical factors related to both IVF exposure and survival, cases were compared using propensity score matching. To control for time-varying patient and treatment factors over the course of ETU care, a marginal structural proportional hazards model (MSPHM) with inverse probability weighting was used to assess for 28-day survival differences. Results Among 424 EVD-positive cases with data for analysis, 354 (83.5%) were treated with IVF at some point during their ETU admission. Overall, 146 (41.3%) cases treated with IVF survived, whereas 31 (44.9%) cases not treated with any IVF survived (P = .583). Matched propensity score analysis found no significant difference in 28-day survival between cases treated and not treated with IVF during their first 24 and 48 hours of care. Adjusted MSPHM survival analyses also found no significant difference in 28-day survival for cases treated with IVF (27.3%) compared to those not treated with IVF (26.9%) during their entire ETU admission (P = .893). Conclusions After adjustment for patient- and treatment-specific time-varying factors, there was no significant difference in survival among patients with EVD treated with IVF as compared to those not treated with IVF. After adjustment for patient- and treatment-specific time varying factors, there was no significant difference in 28-day survival among patients with Ebola virus disease treated with intravenous fluid compared with those not treated with intravenous fluid in a low-resource setting.