Publication:
A simple score to predict the outcome of severe malaria in adults

Issued Date

2010-03-01

Resource Type

Article

ISSN

10584838

DOI

10.1086/649928

Other identifier(s)

2-s2.0-76749157116

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Mahidol University

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SCOPUS

Bibliographic Citation

Clinical Infectious Diseases. Vol.50, No.5 (2010), 679-685

Suggested Citation

Josh Hanson, Sue J. Lee, Sanjib Mohanty, M. A. Faiz, Nicholas M. Anstey, Prakaykaew Charunwatthana, Emran Bin Yunus, Saroj K. Mishra, Emiliana Tjitra, Ric N. Price, Ridwanur Rahman, Francois Nosten, Ye Htut, Gofranul Hoque, Tran Thi Hong Chau, Nguyen Hoan Phu, Tran Tinh Hien, Nicholas J. White, Nicholas P.J. Day, Arjen M. Dondorp A simple score to predict the outcome of severe malaria in adults. Clinical Infectious Diseases. Vol.50, No.5 (2010), 679-685. doi:10.1086/649928 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/29764

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Title

A simple score to predict the outcome of severe malaria in adults

Author(s)

Josh Hanson
 Sue J. Lee
 Sanjib Mohanty
 M. A. Faiz
 Nicholas M. Anstey
 Prakaykaew Charunwatthana
 Emran Bin Yunus
 Saroj K. Mishra
 Emiliana Tjitra
 Ric N. Price
 Ridwanur Rahman
 Francois Nosten
 Ye Htut
 Gofranul Hoque
 Tran Thi Hong Chau
 Nguyen Hoan Phu
 Tran Tinh Hien
 Nicholas J. White
 Nicholas P.J. Day
 Arjen M. Dondorp

Other Contributor(s)

Mahidol University
 Shoklo Malaria Research Unit
 Churchill Hospital
 Ispat Hospital
 Sir Salimullah Medical College
 Shaheed Sharwardhy Medical College
 Chittagong Medical College
 Menzies School of Health Research
 Badan Penelitian Dan Pengembangan Kesehatan, Kementerian Kesehatan Republik Indonesia
 Ministry of Health
 UCL

Abstract

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 <2 predicted survival with a positive predictive value (PPV) of 95.8% (95% confidence interval [CI], 93%- 97.7%). Of the 14 of 331 patients who died with a CAM score <2, 11 (79%) had renal failure and death occurred late after hospital admission (median, 108 h; range, 40-360 h). Substitution of plasma bicarbonate as the measure of acidosis only slightly reduced the prognostic value of the model. Use of respiratory rate was inferior, but a score <2 still predicted survival with a PPV of 92.2% (95% CI, 89.1%-94.7%). Conclusions. Patients with a CAM score <2 at hospital admission may be safely treated in a general ward, provided that renal function can be monitored. © 2010 by the Infectious Diseases Society of America. All rights reserved.

Keyword(s)

Medicine

Availability

URI

https://repository.li.mahidol.ac.th/handle/20.500.14594/29764

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Scopus 2006-2010