Lassa fever outcomes and prognostic factors in Nigeria (LASCOPE): a prospective cohort study

Abstract

Background Lassa fever is a viral haemorrhagic fever endemic in parts of west Africa. New treatments are needed to decrease mortality, but pretrial reference data on the disease characteristics are scarce. We aimed to document baseline characteristics and outcomes for patients hospitalised with Lassa fever in Nigeria. MethodsWe did a prospective cohort study (LASCOPE) at the Federal Medical Centre in Owo, Nigeria. All patients admitted with confirmed Lassa fever were invited to participate and asked to give informed consent. Patients of all ages, including newborn infants, were eligible for inclusion, as were pregnant women. All participants received standard supportive care and intravenous ribavirin according to Nigeria Centre for Disease Control guidelines and underwent systematic biological monitoring for 30 days. Patients' characteristics, care received, mortality, and associated factors were recorded using standard WHO forms. We used univariable and multivariable logistic regression models to investigate an association between baseline characteristics and mortality at day 30.

Clinical characterization of Lassa fever: A systematic review of clinical reports and research to inform clinical trial design

“…[4] The reported case fatality rate (CFR) is approximately 30% in patients who present to health care settings [5]-although this figure is lower (12%) in the most recent large cohort study taking place in a research setting. [6] During the peak season it is possible for large outbreaks to occur. Nigeria has experienced increases of confirmed cases and deaths every year since 2017, although this may be attributed to heightened clinical awareness and improvements in diagnostic capacity.…”

A systematic review of the discrimination and absolute mortality predicted by the National Early Warning Scores according to different cut-off values and prediction windows

“…Fifty-one studies included all patients, 22 were limited to patients with sepsis or suspected sepsis, 12 to medical patients only, 11 to patients with pneumonia or respiratory illness, and 10 to patients with COVID-19 or suspected COVID-19. Other miscellaneous studies were limited to patients specified by illness severity [35,80,[92][93][94][95], older age [64,71], or specific conditions (i.e., cancer [96], Lassa fever [97], gastrointestinal bleeding [70], acute neurology [85], tuberculosis [98], stroke [99], Klebsiella infection [100], and pancreatitis [82]). AMU/MAU = acute medical or medical assessment unit.…”

A standardised Phase III clinical trial framework to assess therapeutic interventions for Lassa fever

“…[4,5] In hospitalised cases, the case fatality rate (CFR) is reported to be 24-27% [6,7] overall and 34% for pregnant women [8]-however in a recent cohort study taking place in a research setting, the CFR for hospitalised cases was 13% for adults and 6% for children. [9] Despite a weak evidence base, the primary treatment for LF is ribavirin in conjunction with supportive care. [4,10] This recommendation is largely based on the results of a single prospective clinical trial that was conducted in the 1980s, which has since generated concern about its methods, analysis and the safety of ribavirin when used to treat mild cases of LF.…”

“…[ 4 , 5 ] In hospitalised cases, the case fatality rate (CFR) is reported to be 24–27% [ 6 , 7 ] overall and 34% for pregnant women [ 8 ]–however in a recent cohort study taking place in a research setting, the CFR for hospitalised cases was 13% for adults and 6% for children. [ 9 ]…”