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

R. HELBOK Clinical Department of Neurology, Innsbruck Medical University, Innsbruck, Austria; Faculty of Tropical Medicine, Mahidol University, Hospital for Tropical Diseases, Bangkok, Thailand

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W. DENT Clinical Department of Neurology, Innsbruck Medical University, Innsbruck, Austria; Faculty of Tropical Medicine, Mahidol University, Hospital for Tropical Diseases, Bangkok, Thailand

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M. NACHER Clinical Department of Neurology, Innsbruck Medical University, Innsbruck, Austria; Faculty of Tropical Medicine, Mahidol University, Hospital for Tropical Diseases, Bangkok, Thailand

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P. LACKNER Clinical Department of Neurology, Innsbruck Medical University, Innsbruck, Austria; Faculty of Tropical Medicine, Mahidol University, Hospital for Tropical Diseases, Bangkok, Thailand

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S. TREEPRASERTSUK Clinical Department of Neurology, Innsbruck Medical University, Innsbruck, Austria; Faculty of Tropical Medicine, Mahidol University, Hospital for Tropical Diseases, Bangkok, Thailand

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S. KRUDSOOD Clinical Department of Neurology, Innsbruck Medical University, Innsbruck, Austria; Faculty of Tropical Medicine, Mahidol University, Hospital for Tropical Diseases, Bangkok, Thailand

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P. WILAIRATANA Clinical Department of Neurology, Innsbruck Medical University, Innsbruck, Austria; Faculty of Tropical Medicine, Mahidol University, Hospital for Tropical Diseases, Bangkok, Thailand

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U. SILACHAMROON Clinical Department of Neurology, Innsbruck Medical University, Innsbruck, Austria; Faculty of Tropical Medicine, Mahidol University, Hospital for Tropical Diseases, Bangkok, Thailand

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S. LOOAREESUWAN Clinical Department of Neurology, Innsbruck Medical University, Innsbruck, Austria; Faculty of Tropical Medicine, Mahidol University, Hospital for Tropical Diseases, Bangkok, Thailand

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E. SCHMUTZHARD Clinical Department of Neurology, Innsbruck Medical University, Innsbruck, Austria; Faculty of Tropical Medicine, Mahidol University, Hospital for Tropical Diseases, Bangkok, Thailand

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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.

Author Notes

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