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Title: Predicting the clinical outcome of severe falciparum malaria in African children: Findings from a large randomized trial
Authors: Lorenz Von Seidlein
Rasaq Olaosebikan
Ilse C.E. Hendriksen
Sue J. Lee
Olanrewaju Timothy Adedoyin
Tsiri Agbenyega
Samuel Blay Nguah
Kalifa Bojang
Jacqueline L. Deen
Jennifer Evans
Caterina I. Fanello
Ermelinda Gomes
Alínia José Pedro
Catherine Kahabuka
Corine Karema
Esther Kivaya
Kathryn Maitland
Olugbenga A. Mokuolu
George Mtove
Juliet Mwanga-Amumpaire
Behzad Nadjm
Margaret Nansumba
Wirichada Pan Ngum
Marie A. Onyamboko
Hugh Reyburn
Tharisara Sakulthaew
Kamolrat Silamut
Antoinette K. Tshefu
Noella Umulisa
Samwel Gesase
Nicholas P.J. Day
Nicholas J. White
Arjen M. Dondorp
Menzies School of Health Research
Royal Victoria Teaching Hospital
Medical Research Council Laboratories Gambia
Mahidol University
University of Ilorin
Komfo Anokye Teaching Hospital
Hospital Central da Beira
Magunga District Hospital
Rwamagana Hospital and Nyanza Hospital
Kilifi District General Hospital
Teule District Hospital
London School of Hygiene & Tropical Medicine
Mbarara Teaching Hospital
Kingasani Health Centre
Keywords: Medicine
Issue Date: 15-Apr-2012
Citation: Clinical Infectious Diseases. Vol.54, No.8 (2012), 1080-1090
Abstract: Background. Data from the largest randomized, controlled trial for the treatment of children hospitalized with severe malaria were used to identify such predictors of a poor outcome from severe malaria.Methods.African children ( < 15 years) with severe malaria participated in a randomized comparison of parenteral artesunate and parenteral quinine in 9 African countries. Detailed clinical assessment was performed on admission. Parasite densities were assessed in a reference laboratory. Predictors of death were examined using a multivariate logistic regression model. Results. Twenty indicators of disease severity were assessed, out of which 5 (base deficit, impaired consciousness, convulsions, elevated blood urea, and underlying chronic illness) were associated independently with death. Tachypnea, respiratory distress, deep breathing, shock, prostration, low pH, hyperparasitemia, severe anemia, and jaundice were statistically significant indicators of death in the univariate analysis but not in the multivariate model. Age, glucose levels, axillary temperature, parasite density, heart rate, blood pressure, and blackwater fever were not related to death in univariate models. Conclusions. Acidosis, cerebral involvement, renal impairment, and chronic illness are key independent predictors for a poor outcome in African children with severe malaria. Mortality is markedly increased in cerebral malaria combined with acidosis.Clinical Trial Registration.ISRCTN50258054. © 2012 The Author.
ISSN: 15376591
Appears in Collections:Scopus 2011-2015

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