A Simple Score to Predict the Outcome of Severe Malaria in Adults

Background. World Health Organization treatment guidelines recommend that adults with severe malaria be admitted to an intensive care unit (ICU). However, ICU facilities are limited in the resource-poor settings where most malaria occurs. Identification of patients at greater risk of complications m...

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Bibliographic Details
Published in:Clinical infectious diseases 2010-03, Vol.50 (5), p.679-685
Main Authors: Hanson, Josh, Lee, Sue J., Mohanty, Sanjib, Faiz, M.A., Anstey, Nicholas M., Charunwatthana, Prakay kaew, Yunus, Emran Bin, Mishra, Saroj K., Tjitra, Emiliana, Price, Ric N., Rahman, Ridwanur, Nosten, Francois, Htut, Ye, Hoque, Gofranul, Chau, Tran Thi Hong, Phu, Nguyen Hoan, Hien, Tran Tinh, White, Nicholas J., Day, Nicholas P. J., Dondorp, Arjen M.
Format: Article
Language:English
Subjects:
Acidosis
Acidosis - pathology
Adult
Adults
ARTICLES AND COMMENTARIES
Bangladesh
Biological and medical sciences
Chemical bases
Coma - pathology
Datasets
Falciparum malaria
Female
Health outcomes
Hematocrit
Hospital admissions
Human protozoal diseases
Humans
Infectious diseases
Intensive care units
Malaria
Malaria - diagnosis
Malaria - mortality
Malaria - pathology
Male
Medical sciences
Medical treatment
Mortality
Parasitic diseases
Plasma
Prognosis
Protozoal diseases
Resource allocation
Severity of Illness Index
Vietnam
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Summary:Background. World Health Organization treatment guidelines recommend that adults with severe malaria be admitted to an intensive care unit (ICU). However, ICU facilities are limited in the resource-poor settings where most malaria occurs. Identification of patients at greater risk of complications may facilitate their triage and resource allocation. Methods. With use of data from a trial conducted in Southeast Asia (n=868), a logistic regression model was built to identify independent predictors of mortality among adults with severe malaria. A scoring system based on this model was tested in the original dataset and then validated in 2 series from Bangladesh (n=188) and Vietnam (n=292). Results. Acidosis (base deficit) and cerebral malaria (measured as Glasgow Coma Score) were the main independent predictors of outcome. The 5-point Coma Acidosis Malaria (CAM) score was simply derived from these 2 variables. Mortality increased steadily with increasing score. A CAM score
ISSN:1058-4838
1537-6591
DOI:10.1086/649928