TY - JOUR
T1 - A simple score to predict the outcome of severe malaria in adults
AU - Hanson, Josh
AU - Lee, Sue
AU - Mohanty, Sanjib
AU - Faiz, M
AU - Anstey, Nicholas
AU - Charunwatthana, Prakaykaew
AU - Yunus, Emran
AU - Mishra, Saroj
AU - Tjitra, E
AU - Price, Ric
AU - Rahman, Ridwanur
AU - Nosten, Francois
AU - Htut, Ye
AU - Hoque, Gofranul
AU - Hong Chau, Tran Thi
AU - Phu, Nguyenhoan
AU - Hien, Tran
AU - White, Nicholas
AU - Day, Nicholas
AU - Dondorp, Arjen
PY - 2010/3/1
Y1 - 2010/3/1
N2 - Background. World Health Organization treatment guidelines recommend that adults with severe malaria be admitted to an intensive care unit (ICU). However, ICU facilities are limited in the resource-poor settings where most malaria occurs. Identification of patients at greater risk of complications may facilitate their triage and resource allocation. Methods. With use of data from a trial conducted in Southeast Asia (n = 868), a logistic regression model was built to identify independent predictors of mortality among adults with severe malaria. A scoring system based on this model was tested in the original dataset and then validated in 2 series from Bangladesh (n = 188) and Vietnam (n = 292). Results. Acidosis (base deficit) and cerebral malaria (measured as Glasgow Coma Score) were the main independent predictors of outcome. The 5-point Coma Acidosis Malaria (CAM) score was simply derived from these 2 variables. Mortality increased steadily with increasing score. A CAM score <2 predicted survival with a positive predictive value (PPV) of 95.8% (95% confidence interval [CI], 93%- 97.7%). Of the 14 of 331 patients who died with a CAM score <2, 11 (79%) had renal failure and death occurred late after hospital admission (median, 108 h; range, 40-360 h). Substitution of plasma bicarbonate as the measure of acidosis only slightly reduced the prognostic value of the model. Use of respiratory rate was inferior, but a score <2 still predicted survival with a PPV of 92.2% (95% CI, 89.1%-94.7%). Conclusions. Patients with a CAM score <2 at hospital admission may be safely treated in a general ward, provided that renal function can be monitored.
AB - Background. World Health Organization treatment guidelines recommend that adults with severe malaria be admitted to an intensive care unit (ICU). However, ICU facilities are limited in the resource-poor settings where most malaria occurs. Identification of patients at greater risk of complications may facilitate their triage and resource allocation. Methods. With use of data from a trial conducted in Southeast Asia (n = 868), a logistic regression model was built to identify independent predictors of mortality among adults with severe malaria. A scoring system based on this model was tested in the original dataset and then validated in 2 series from Bangladesh (n = 188) and Vietnam (n = 292). Results. Acidosis (base deficit) and cerebral malaria (measured as Glasgow Coma Score) were the main independent predictors of outcome. The 5-point Coma Acidosis Malaria (CAM) score was simply derived from these 2 variables. Mortality increased steadily with increasing score. A CAM score <2 predicted survival with a positive predictive value (PPV) of 95.8% (95% confidence interval [CI], 93%- 97.7%). Of the 14 of 331 patients who died with a CAM score <2, 11 (79%) had renal failure and death occurred late after hospital admission (median, 108 h; range, 40-360 h). Substitution of plasma bicarbonate as the measure of acidosis only slightly reduced the prognostic value of the model. Use of respiratory rate was inferior, but a score <2 still predicted survival with a PPV of 92.2% (95% CI, 89.1%-94.7%). Conclusions. Patients with a CAM score <2 at hospital admission may be safely treated in a general ward, provided that renal function can be monitored.
UR - http://www.scopus.com/inward/record.url?scp=76749157116&partnerID=8YFLogxK
U2 - 10.1086/649928
DO - 10.1086/649928
M3 - Article
VL - 50
SP - 679
EP - 685
JO - Clinical Infectious Diseases
JF - Clinical Infectious Diseases
SN - 1058-4838
IS - 5
ER -