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THE USE OF THE MULTI-ORGAN-DYSFUNCTION SCORE TO DISCRIMINATE DIFFERENT LEVELS OF SEVERITY IN SEVERE AND COMPLICATED PLASMODIUM FALCIPARUM MALARIA

Clinical presentation of Plasmodium falciparum malaria reflects a continuum from asymptomatic to multi-organ manifestation and death. Severe malaria is defined by the World Health Organization as a qualitative variable. We used the multi-organ dysfunction score (MODS) as a quantitative approach for severity in 29 patients with severe and complicated P. falciparum malaria to test its usefulness in discriminating different severity levels. The MODS on admission was highly correlated with the duration of symptoms after admission (r = 0.73, P < 0.001) and the serum level of tumor necrosis factor alpha (r = 0.41, P = 0.03). In addition, the simplified MODS, based mainly on clinical findings, was also correlated with liver and renal dysfunction during hospitalization (alanine transaminase, r = 0.42, P = 0.02; blood urea nitrogen, r = 0.45, P = 0.015). A score 16 was associated with significantly longer disease duration (P = 0.018). Thus, this score might provide a predictive value for morbidity in P. falciparum malaria.

Received May 6, 2004. Accepted for publication September 20, 2004.

Acknowledgments: We are indebted to Professor Rachanee Udomsangpetch and Dr. Yupaporn Wattanagoon for their support, contributions, and helpful critical review of the manuscript; to the nurses of Bangkok Hospital for Tropical Diseases, whose dedication to excellence in both patient care and research made this study possible, and to all the patients who took part in this study.

Financial support: This study was supported by a grant from Mahidol University (Bangkok, Thailand) and the Department of Neurology, University Innsbruck (Innsbruck Austria), and by the National Institutes of Health grant ROI AI51310.

Authors’ addresses: R. Helbok, W. Dent, P. Lackner, and E. Schmutzhard, Department of Neurology, University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria. M. Nacher, S. Treeprasertsuk, S. Krudsood, P. Wilairatana, U. Silachamroon, and S. Looareesuwan, Faculty of Tropical Medicine, Hospital for Tropical Diseases, 420/6 Ratchavithi Road, 10400 Bangkok, Thailand.

Reprint requests: R. Helbok, Department of Neurology, University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria, Fax: 43-512-504-4243, E-mail: raimund_helbok{at}yahoo.com.

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