Relationship between Viremia and Specific Organ Damage in Ebola Patients: A Cohort Study

Simone Lanini, Gina Portella, Francesco Vairo, Gary P. Kobinger, Antonio Pesenti, Martin Langer, Soccoh Kabia, Giorgio Brogiato, Jackson Amone, Concetta Castilletti, Rossella Miccio, Maria Rosaria Capobianchi, Gino Strada, Alimuddin Zumla, Antonino Di Caro, Giuseppe Ippolito, Mirella Biava, Angela Cannas, Roberta Chiappini, Sabrina CoenFrancesca Colavita, Germana Grassi, Daniele Lapa, Antonio Mazzarelli, Silvia Meschi, Claudia Minosse, Serena Quartu, Maria Beatrice Valli, Carolina Venditti, Antonella Vulcano, Paola Zaccaro, Umar Ahmad, Elisabetta Checcarelli, Michela Delli Guanti, Elena Giovanella, Davide Gottardello, Maurizio Guastalegname, Milos Jocic, Giorgio Monti, Clare Parsons, Nicola Rossi, Giampiero Salvati, Giovanna Scaccabarozzi, Erminio Sisillo, Paola Tagliabue, Marta Turella, Caterina Valdatta

Research output: Contribution to journalArticlepeer-review


Background. Pathogenesis of Ebola virus disease remains poorly understood. We used concomitant determination of routine laboratory biomarkers and Ebola viremia to explore the potential role of viral replication in specific organ damage. Methods. We recruited patients with detectable Ebola viremia admitted to the EMERGENCY Organizzazione Non Governativa Organizzazione Non Lucrativa di Utilità Sociale (ONG ONLUS) Ebola Treatment Center in Sierra Leone. Repeated measure of Ebola viremia, alanine aminotransferase (ALT), aspartate aminotransferase (AST), bilirubin, creatine phosphokinase (CPK), lactate dehydrogenase (LDH), activated prothrombin time (aPTT), international normalized ratio (INR), creatinine, and blood urea nitrogen (BUN) were recorded. Patients were followed up from admission until death or discharge. Results. One hundred patients (49 survivors and 51 nonsurvivors) were included in the analysis. Unadjusted analysis to compare survivors and nonsurvivors provided evidence that all biomarkers were significantly above the normal range and that the extent of these abnormalities was generally higher in nonsurvivors than in survivors. Multivariable mixed-effects models provided strong evidence for a biological gradient (suggestive of a direct role in organ damage) between the viremia levels and either ALT, AST, CPK LDH, aPTT, and INR. In contrast, no direct linear association was found between viremia and either creatinine, BUN, or bilirubin. Conclusions. This study provides evidence to support that Ebola virus may have a direct role in muscular damage and imbalance of the coagulation system. We did not find strong evidence suggestive of a direct role of Ebola virus in kidney damage. The role of the virus in liver damage remains unclear, but our evidence suggests that acute severe liver injury is not a typical feature of Ebola virus disease.

Original languageEnglish (US)
Pages (from-to)36-44
Number of pages9
JournalClinical Infectious Diseases
Issue number1
StatePublished - Jan 1 2018
Externally publishedYes


  • Ebola virus
  • biomarkers
  • liver function
  • muscle damage
  • renal function.

ASJC Scopus subject areas

  • Microbiology (medical)
  • Infectious Diseases


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