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Prognostic indicators in adults hospitalized with falciparum malaria in Western Thailand.

Newton, PN; Stepniewska, K; Dondorp, A; Silamut, K; Chierakul, W; Krishna, S; Davis, TM; Suputtamongkol, Y; Angus, B; Pukrittayakamee, S; et al. Newton, PN; Stepniewska, K; Dondorp, A; Silamut, K; Chierakul, W; Krishna, S; Davis, TM; Suputtamongkol, Y; Angus, B; Pukrittayakamee, S; Ruangveerayuth, R; Hanson, J; Day, NP; White, NJ (2013) Prognostic indicators in adults hospitalized with falciparum malaria in Western Thailand. Malaria Journal, 12 (229). pp. 1-14. ISSN 1475-2875 https://doi.org/10.1186/1475-2875-12-229
SGUL Authors: Krishna, Sanjeev

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Abstract

Background: Severe malaria remains a major cause of death and morbidity amongst adults in the Asiatic tropics. Methods: A retrospective analysis of the clinical and laboratory data of 988 adult patients, hospitalized with Plasmodium falciparum malaria and prospectively recruited to malaria studies in western Thailand between 1986 and 2002, was performed to assess the factors associated with a fatal outcome. Different severity scores and classifications for defining severe malaria were compared and, using multiple logistic regression, simple models for predicting mortality developed. Results: The proportion of patients fulfilling the WHO 2000 definition of severe malaria was 78.1%, and their mortality was 10%. Mortality in patients given parenteral artesunate or artemether (16/317, 5%) was lower than in those given parenteral quinine (59/442, 13%) (P < 0.001). Models using parameter sets based on WHO 1990, 2000 and Adapted AQ criteria plus blood smear parasite-stage assessment gave the best mortality prediction. A malaria prognostic index (MPI), derived from the dataset using five clinical or laboratory variables gave similar prognostic accuracy. Conclusions: The mortality of severe malaria in adults has fallen and the switch from quinine to artesunate has probably been an important contributor. Prognostic indices based on WHO 2000 definitions, and other simpler indices based on fewer variables, provide clinically useful predictions of outcome in Asian adults with severe malaria.

Item Type: Article
Additional Information: Copyright ©2013 Newton et al.; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Keywords: Science & Technology, Life Sciences & Biomedicine, Parasitology, Tropical Medicine, Malaria, Mortality, Thailand, Plasmodium falciparum, Prognosis, ACUTE-RENAL-FAILURE, CEREBRAL MALARIA, RANDOMIZED-TRIAL, AFRICAN CHILDREN, QUININE, ARTESUNATE
SGUL Research Institute / Research Centre: Academic Structure > Infection and Immunity Research Institute (INII)
Journal or Publication Title: Malaria Journal
ISSN: 1475-2875
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Dates:
DateEvent
8 July 2013Published
Web of Science ID: WOS:000321775000001
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URI: https://openaccess.sgul.ac.uk/id/eprint/102147
Publisher's version: https://doi.org/10.1186/1475-2875-12-229

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