Abstract: Background　From March 2014 to October 2015，Ebola virus disease （EVD） in the Republic of Sierra Leone caused 8 690 cumulative confirmed cases and 3 588 deaths country-wide.Understanding the epidemiological characteristics of EVD deaths is of great significance for improving disease resistance and reducing disaster losses.Objective　To analyze the epidemiological characteristics of EVD deaths.Methods　The retrospective study of the morbidity，mortality，and time and geographical distributions of death cases of EVD was done with clinical and demographic data mainly collected from medical records of Jui Government Hospital from March 2014 to October 2015，and with supplemented data from records of National Ebola Response Center of Sierra Leone（http：//www.nerc.sl/） and World Health Organization（http：//www.who.int/csr/disease/ebola/en/）．Other data of 747 EVD cases（442 survived and 305 died） diagnosed by Jui Government Hospital were also collected，including gender，age，interval between EVD onset time and admission time，viral load，clinical symptoms，length of stay，discharge or death time.Results　In Sierra Leone from March 2014 to October 2015，the incidence rate of EVD was 0.12%（8 690/7 120 722），and the case fatality rate（CFR） of EVD was 41.28%（3 588/8 690）．On March 31，2014，the Ministry of Health of Sierra Leone reported 6 possible and suspicious cases，of whom 5 died （case fatality rate was 5/6）．It fell to a lower level in September 2014 〔29.94% （605/2 021） 〕 and remained basically at a lower level after December 2014.CFR of EVD in Freetown，the capital city，was lower〔38.88%（1 341/3 449）〕.Districts near the capital showed relatively lower CFR，but those far from the capital showed relatively higher CFR.The decreased had greater average age，longer average interval between onset time and admission time，higher rates of weakness，abdominal pain，dyspnea，skin rash and disturbance of consciousness，but had lower average viral load （CT value），and lower rates of fever，vomiting，anorexia，and joint pain compared with the survived（P<0.05）．Multivariate Logistic regression analysis found that the interval between EVD onset time and admission time〔OR=1.510，95%CI（1.373，1.661）〕，viral load （CT value） 〔OR=0.937，95%CI（0.892，0.985）〕，vomiting 〔OR=0.576，95%CI（0.343，0.966）〕，weakness〔OR=0.162，95%CI（0.049，0.533）〕，dyspnea〔OR=1.715，95%CI（1.025，2.871）〕and disturbance of consciousness〔OR=0.389，95%CI（0.217，0.696）〕were independent prognostic factors of EVD（P<0.05）．Conclusion　Several factors influenced the outcome of EVD.Coordinated international response is deemed essential to reduce the death cases.Transportation condition could be one of the main factors relating to the mortality rate，earlier admission would improve the prognosis.Older age is associated with a higher risk of death.Clinical characteristics including vomiting，weakness，dyspnea and disturbance of consciousness are also related to prognosis of the disease.

Key words: Hemorrhagic fever, ebola；Ebolavirus；Sierra Leone；Epidemiologic studies

摘要： 背景　2014年3月—2015年10月，塞拉利昂暴发埃博拉出血热（EVD），造成累计确诊病例8 690例，死亡3 588例。了解EVD死亡病例流行病学特征对于提高抗疫能力，减少灾害损失意义重大。目的　分析EVD死亡病例的流行病学特征。方法　采用回顾性分析方法，病例信息来源于2014年3月—2015年10月Jui Government Hospital确诊病例，同时参考塞拉利昂国家埃博拉疫情报告中心（http：//www.nerc.sl/）及世界卫生组织（WHO）（http：//www.who.int/csr/disease/ebola/en/）记录的数据。收集Jui Government Hospital、塞拉利昂国家埃博拉疫情报告中心、WHO记录的所有发病及死亡患者信息，分析其发病率、死亡率及死亡时间、地域分布；收集Jui Government Hospital确诊患者的病例资料，包括：性别、年龄、起病到入院时间、病毒载量、临床症状、住院时间、出院或死亡时间等。共收集747例患者的病例资料，根据预后分为存活442例，死亡305例。结果　2014年3月—2015年10月，约有8 690例（同期塞拉利昂总人数7 120 722人）确诊EVD，其中死亡3 588例，发病率为0.12%，病死率为41.28%。2014-03-31，塞拉利昂卫生部报告了6例可能和可疑病例，其中死亡5例（病死率为5/6）。2014年9月下降至较低水平〔29.94%（605/2 021）〕，至2014年12月后基本平稳于较低值。首都弗里敦EVD病死率较低〔38.88%（1 341/3 449）〕；距离首都较近的地区EVD病死率较低，距离首都较远的地区EVD病死率较高。死亡患者年龄、起病到入院时间、乏力、腹痛、呼吸困难、皮疹、意识模糊发生率高于存活患者，病毒载量（CT值）、发热、呕吐、厌食、关节痛低于存活患者（P<0.05）。多因素Logistic回归分析结果显示，起病到入院时间〔OR=1.510，95%CI（1.373，1.661）〕、病毒载量（CT值）〔OR=0.937，95%CI（0.892，0.985）〕、呕吐〔OR=0.576，95%CI（0.343，0.966）〕、乏力〔OR=0.162，95%CI（0.049，0.533）〕、呼吸困难〔OR=1.715，95%CI（1.025，2.871）〕及意识模糊〔OR=0.389，95%CI（0.217，0.696）〕是EVD患者预后的独立影响因素（P<0.05）。结论　影响埃博拉感染病例死亡的因素中，国际援助被认为是减少死亡案例的关键。交通条件可能是影响死亡率的主要因素之一，较早的到达医院治疗会改善埃博拉出血热的预后。老年患者死亡风险较高。临床特征如呕吐、乏力、呼吸困难、昏迷等和预后有相关性。

关键词: 出血热, 埃博拉；埃博拉病毒；塞拉利昂；流行病学研究