title: Predictors of mortality in severe malaria: a two year experience in a non-endemic area.
abstract: Management of severe malaria is an increasing problem worldwide. This paper reviews the pathophysiology and management documenting two years' experience of admissions of severe malaria to an ICU in a non-endemic area. Clinical and laboratory features of severe malaria were analysed for predictors of mortality Twenty-eight patients had clinical or laboratory features compatible with the WHO criteria for severe malaria and, despite treatment with intravenous quinine and supportive ICU care, mortality was 28.5% (8/28). The three pregnant patients died with 100% foetal mortality and the four paediatric patients survived. Of the non-survivors, 8/8 developed ARDS (defined by worst ALI score > 2.5), 7/8 developed shock requiring inotropic support and 7/8 developed acute renal failure requiring CVVHD. Admission haemoglobin, platelet count, parasite count, and lowest Glasgow Coma Score in the first 24 hours were shown not to be predictors of mortality.
authors.affiliation: South African Institute of Medical Research and University of the Witwatersrand Hospital, South Africa.
authors.forename: L
authors.initials: L
authors.lastname: Blumberg
authors.forename: R P
authors.initials: RP
authors.lastname: Lee
authors.forename: J
authors.initials: J
authors.lastname: Lipman
authors.forename: S
authors.initials: S
authors.lastname: Beards
mesh_terms: D058186:Acute Kidney Injury / Q000453:epidemiology / Q000628:therapy; D000328:Adult; D000368:Aged; D000818:Animals; D000962:Antimalarials / Q000008:administration & dosage / Q000627:therapeutic use; D002316:Cardiotonic Agents / Q000627:therapeutic use; D002675:Child, Preschool; D003422:Critical Care; D005260:Female; D005313:Fetal Death; D005544:Forecasting; D015600:Glasgow Coma Scale; D017583:Hemodiafiltration; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D007223:Infant; D007275:Injections, Intravenous; D008288:Malaria / Q000188:drug therapy / Q000401:mortality* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D010343:Patient Admission; D010961:Plasmodium / Q000302:isolation & purification; D010976:Platelet Count; D011247:Pregnancy; D011803:Quinine / Q000008:administration & dosage / Q000627:therapeutic use; D012128:Respiratory Distress Syndrome / Q000401:mortality; D012769:Shock / Q000188:drug therapy / Q000453:epidemiology; D013019:South Africa / Q000453:epidemiology; D015996:Survival Rate; D014944:World Health Organization
chemical_list: D000962:Antimalarials; D002316:Cardiotonic Agents; D006454:Hemoglobins; D011803:Quinine