title: Prognostic value of circulating pigmented cells in African children with malaria.
abstract: BACKGROUND
  Plasmodium falciparum malaria is a common cause of morbidity in African children, but identifying those who are likely to die is problematic. Previous studies suggested that circulating malarial pigment might be a useful predictor of severity, but none were large enough to detect any association with mortality.
  
  
  METHODS
  We used thick blood smears performed on admission for 26,296 children hospitalized with P. falciparum at 1 of 6 hospitals in the Severe Malaria in African Children network to assess the prognostic value of pigment-containing granulocytes, monocytes, and parasites.
  
  
  RESULTS
  Although at all but one of the study sites the risk of mortality for subjects presenting with >5 pigmented granulocytes per 200 white blood cells was higher than in subjects with no pigmented granulocytes, adjusted odds ratios estimated through logistic regression, which included other established markers of severe malaria, suggested that associations between pigmented cells and mortality were moderate to nonexistent in most sites. The predictive ability of pigmented cells was low, as measured by the change in the area under the receiver operating characteristic curve of logistic regression models.
  
  
  CONCLUSIONS
  Although high levels of pigmented cells were associated with a fatal outcome in some study sites, they were not useful predictors of outcome across Africa.
authors.affiliation: Medical Research Unit, Albert Schweitzer Hospital, Lambaréné, Gabon.
authors.forename: Peter Gottfried
authors.initials: PG
authors.lastname: Kremsner
authors.forename: Clarissa
authors.initials: C
authors.lastname: Valim
authors.forename: Michel A
authors.initials: MA
authors.lastname: Missinou
authors.forename: Christopher
authors.initials: C
authors.lastname: Olola
authors.forename: Sanjeev
authors.initials: S
authors.lastname: Krishna
authors.forename: Saadou
authors.initials: S
authors.lastname: Issifou
authors.forename: Maryvonne
authors.initials: M
authors.lastname: Kombila
authors.forename: Lloyd
authors.initials: L
authors.lastname: Bwanaisa
authors.forename: Sadik
authors.initials: S
authors.lastname: Mithwani
authors.forename: Charles R
authors.initials: CR
authors.lastname: Newton
authors.forename: Tsiri
authors.initials: T
authors.lastname: Agbenyega
authors.forename: Margaret
authors.initials: M
authors.lastname: Pinder
authors.forename: Kalifa
authors.initials: K
authors.lastname: Bojang
authors.forename: David
authors.initials: D
authors.lastname: Wypij
authors.forename: Terrie
authors.initials: T
authors.lastname: Taylor
mesh_terms: D000349:Africa / Q000453:epidemiology; D000818:Animals; D000953:Antigens, Protozoan / Q000097:blood*; D002675:Child, Preschool; D006801:Humans; D007223:Infant; D016778:Malaria, Falciparum / Q000097:blood / Q000175:diagnosis* / Q000453:epidemiology / Q000401:mortality; D010858:Pigmentation; D010860:Pigments, Biological / Q000097:blood*; D010963:Plasmodium falciparum; D011379:Prognosis; D012720:Severity of Illness Index; D016019:Survival Analysis; D017741:Survivors
chemical_list: D000953:Antigens, Protozoan; D010860:Pigments, Biological