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Title: Prognostic indicators in adults hospitalized with falciparum malaria in Western Thailand
Authors: Paul N. Newton
Kasia Stepniewska
Arjen Dondorp
Kamolrat Silamut
Wirongrong Chierakul
Sanjeev Krishna
Timothy Me Davis
Yupin Suputtamongkol
Brian Angus
Sasithon Pukrittayakamee
Ronnatrai Ruangveerayuth
Josh Hanson
Nicholas Pj Day
Nicholas J. White
Wellcome Trust
Mahidol University
Nuffield Department of Clinical Medicine
University of London
University of Western Australia
Faculty of Medicine, Siriraj Hospital, Mahidol University
Mae Sot General Hospital
Menzies School of Health Research
Keywords: Immunology and Microbiology;Medicine
Issue Date: 11-Jul-2013
Citation: Malaria Journal. Vol.12, No.1 (2013)
Abstract: Background: Severe malaria remains a major cause of death and morbidity amongst adults in the Asiatic tropics. Methods. A retrospective analysis of the clinical and laboratory data of 988 adult patients, hospitalized with Plasmodium falciparum malaria and prospectively recruited to malaria studies in western Thailand between 1986 and 2002, was performed to assess the factors associated with a fatal outcome. Different severity scores and classifications for defining severe malaria were compared and, using multiple logistic regression, simple models for predicting mortality developed. Results: The proportion of patients fulfilling the WHO 2000 definition of severe malaria was 78.1%, and their mortality was 10%. Mortality in patients given parenteral artesunate or artemether (16/317, 5%) was lower than in those given parenteral quinine (59/442, 13%) (P < 0.001). Models using parameter sets based on WHO 1990, 2000 and Adapted AQ criteria plus blood smear parasite-stage assessment gave the best mortality prediction. A malaria prognostic index (MPI), derived from the dataset using five clinical or laboratory variables gave similar prognostic accuracy. Conclusions: The mortality of severe malaria in adults has fallen and the switch from quinine to artesunate has probably been an important contributor. Prognostic indices based on WHO 2000 definitions, and other simpler indices based on fewer variables, provide clinically useful predictions of outcome in Asian adults with severe malaria. © 2013 Newton et al.; licensee BioMed Central Ltd.
ISSN: 14752875
Appears in Collections:Scopus 2011-2015

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