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Prognostic indicators in adults hospitalized with falciparum malaria in Western Thailand

Newton, Paul N., Stepniewska, Kasia, Dondorp, Arjen M., Silamut, Kamolrat, Chierakul, Wirongrong, Krishna, Sanjeev, Davis, Timothy M. E., Suputtamongkol, Yupin, Angus, Brian, Pukrittayakamee, Sasithon, Ruangveerayuth, Ronnatrai, Hanson, Josh, Day, Nicholas P. J. and White, Nicholas J. (2013). Prognostic indicators in adults hospitalized with falciparum malaria in Western Thailand. Malaria Journal,12(1):229-1-229-14.

Document type: Journal Article
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IRMA ID cmartelxPUB159
Title Prognostic indicators in adults hospitalized with falciparum malaria in Western Thailand
Author Newton, Paul N.
Stepniewska, Kasia
Dondorp, Arjen M.
Silamut, Kamolrat
Chierakul, Wirongrong
Krishna, Sanjeev
Davis, Timothy M. E.
Suputtamongkol, Yupin
Angus, Brian
Pukrittayakamee, Sasithon
Ruangveerayuth, Ronnatrai
Hanson, Josh
Day, Nicholas P. J.
White, Nicholas J.
Journal Name Malaria Journal
Publication Date 2013
Volume Number 12
Issue Number 1
ISSN 1475-2875   (check CDU catalogue  open catalogue search in new window)
Start Page 229-1
End Page 229-14
Total Pages 14
Place of Publication United Kingdom
Publisher BioMed Central Ltd.
HERDC Category C1 - Journal Article (DIISR)
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.


Keywords Malaria
Mortality
Thailand
Plasmodium falciparum
Prognosis
DOI http://dx.doi.org/10.1186/1475-2875-12-229   (check subscription with CDU E-Gateway service for CDU Staff and Students  check subscription with CDU E-Gateway in new window)
Additional Notes This is an Open Access article distributed under the terms of the Creative Commons Attribution License 2.0, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Description for Link Link to CC Attribution 2.0 License
URL https://creativecommons.org/licenses/by/2.0/au/legalcode


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