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Hemoglobin Concentration and Parasitemia on Hospital Admission Predict Risk of Multiple Organ Dysfunction Syndrome among Adults with Malaria

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  • University of Michigan School of Public Health, Department of Epidemiology, Ann Arbor, Michigan; Central Military Hospital, Department of Critical Medicine, Bogotá, Colombia; University of La Sabana, Faculty of Medicine, Chia, Colombia

Risk factors for progression from acute malaria to multiple organ dysfunction syndrome (MODS) are poorly understood. The MODS is commonly diagnosed with the sequential organ failure assessment (SOFA) scale, but this scale has been understudied in patients with severe malaria. We conducted a cohort study among 426 adult males admitted to hospital with malaria in Bogotá, Colombia. We estimated SOFA scores and relative risks (RRs) for MODS during hospitalization according to patients' characteristics on admission. Risk of MODS was 7.3% over a median 6.0 days in hospital. Baseline hemoglobin was strongly, inversely associated with MODS (adjusted RR for hemoglobin ≤ 8.5 g/dL versus hemoglobin > 11 g/dL = 9.5, 95% confidence interval [CI]: 3.6, 25.3). Plasmodium falciparum malaria and parasitemia were positively associated with MODS. There was a strong interaction between baseline parasitemia and hemoglobin on MODS risk. In conclusion, the use of parasitemia and hemoglobin on admission to identify high-risk patients deserves consideration.

Author Notes

* Address correspondence to Eduardo Villamor, University of Michigan School of Public Health, Department of Epidemiology, 1415 Washington Heights, Ann Arbor, MI 48109. E-mail: villamor@umich.edu

Financial support: This project was funded by the University of Michigan, Department of Epidemiology.

Authors' addresses: Emily Walton and Eduardo Villamor, University of Michigan School of Public Health, Department of Epidemiology, Ann Arbor, MI, E-mails: ewalt@umich.edu and villamor@umich.edu. Henry Oliveros, Central Military Hospital, Department of Critical Medicine, Bogotá, Colombia, E-mail: henryor@unisabana.edu.co.

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