1921
Volume 100, Issue 4
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645
USD
Buy:$15.00

Abstract

Abstract.

We aimed to identify clinical and laboratory predictors of mortality in children from a malaria-endemic area of Papua New Guinea hospitalized for severe illness. Children aged 0.5–10 years presenting with any WHO-defined feature of severe malarial illness were eligible for recruitment. Each child was assessed with a detailed clinical examination, blood film microscopy, malaria rapid diagnostic testing (RDT), a full blood examination, and blood glucose and lactate concentrations. Clinical care was coordinated by local medical staff in accordance with national guidelines. Daily study assessments were conducted until death or discharge. Other biochemical tests and malaria polymerase chain reaction (PCR) tests were performed subsequently. Logistic regression identified independent predictors of death. Of 787 evaluable children with severe illness, 336 had confirmed severe malaria (microscopy and PCR positive) and 58 (6.6%) died during hospitalization. The independent predictors of mortality were hyperlactatemia (adjusted odds ratio [95% CI]: 2.85 [1.24–6.41], = 0.01), malnutrition (2.92 [1.36–6.23], = 0.005), renal impairment (3.85 [1.53–9.24], = 0.002), plasma albumin (0.93 [0.88–0.98] for a 1 g/L increase, = 0.004), and Blantyre coma score (BCS) ≤ 2 (10.3 [4.77–23.0] versus a normal BCS, < 0.0001). Confirmed severe malaria (0.11 [0.03–0.30] versus non-malarial severe illness, < 0.0001) was independently associated with lower mortality. Although established risk factors were evident, malaria was inversely associated with mortality. This highlights the importance of accurate diagnosis through blood film microscopy, RDTs, and, if available, PCR to both guide management and provide valid epidemiological data.

Loading

Article metrics loading...

The graphs shown below represent data from March 2017
/content/journals/10.4269/ajtmh.18-0769
2019-02-18
2019-08-17
Loading full text...

Full text loading...

http://instance.metastore.ingenta.com/content/journals/10.4269/ajtmh.18-0769
Loading
/content/journals/10.4269/ajtmh.18-0769
Loading

Data & Media loading...

  • Received : 22 Sep 2018
  • Accepted : 10 Dec 2018
  • Published online : 18 Feb 2019

Most Cited This Month

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error