Contribution of Malaria to Inhospital Mortality in Papua New Guinean Children from a Malaria-Endemic Area: A Prospective Observational Study
| Autor: | Timothy M. E. Davis, Susan Aipit, Moses Laman, Laurens Manning, Jimmy Aipit, Cathy Bona |
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| Jazyk: | angličtina |
| Rok vydání: | 2019 |
| Předmět: |
Male
medicine.medical_specialty Endemic Diseases 030231 tropical medicine Plasmodium falciparum Physical examination Antigens Protozoan 03 medical and health sciences Papua New Guinea 0302 clinical medicine Predictive Value of Tests Virology Internal medicine Epidemiology parasitic diseases medicine Odds Ratio Humans Hospital Mortality Prospective Studies Prospective cohort study Child medicine.diagnostic_test biology business.industry Infant Odds ratio Articles medicine.disease biology.organism_classification Malaria Malnutrition Infectious Diseases Logistic Models Predictive value of tests Child Preschool Parasitology Female business |
| Popis: | 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], P = 0.01), malnutrition (2.92 [1.36-6.23], P = 0.005), renal impairment (3.85 [1.53-9.24], P = 0.002), plasma albumin (0.93 [0.88-0.98] for a 1 g/L increase, P = 0.004), and Blantyre coma score (BCS) ≤ 2 (10.3 [4.77-23.0] versus a normal BCS, P < 0.0001). Confirmed severe malaria (0.11 [0.03-0.30] versus non-malarial severe illness, P < 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. |
| Databáze: | OpenAIRE |
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