The Lambaréné Organ Dysfunction Score (LODS) is a simple clinical predictor of fatal malaria in African children.
BACKGROUND
Plasmodium falciparum malaria accounts for >1 million deaths annually, mostly among young children in sub-Saharan Africa. Identifying those individuals who are likely to die is crucial. Several factors have been independently associated with death. Because malaria is a systemic disease, a quantitative score combining such risk factors may be superior.


METHODS
We used both forward and backward stepwise logistic regression to select the best predictors of death, as evaluated for 23,890 African children with severe P. falciparum malaria. The study was conducted from December 2000 through May 2005 in 6 hospital-based research units (in Banjul in the Gambia, Blantyre in Malawi, Kilifi in Kenya, Kumasi in Ghana, and Lambaréné and Libreville in Gabon) in a network established to study severe malaria in African children (ie, the SMAC Network).


RESULTS
The Lambaréné Organ Dysfunction Score (LODS) combines 3 variables: coma, prostration, and deep breathing. A LODS >0 (odd ratio, 9.6; 95% confidence interval, 8.0-11.4) has 85% sensitivity to predict death, and a LODS <3 is highly (98%) specific for survival.


CONCLUSIONS
The LODS is a simple clinical predictor of fatal malaria in African children. This score provides accurate and rapid identification of children needing either referral or increased attention.
Helbok
Raimund
R
Medical Research Unit, Albert Schweitzer Hospital, Lambaréné, Gabon. raimund.helbok@uki.at
Kendjo
Eric
E
Issifou
Saadou
S
Lackner
Peter
P
Newton
Charles R
CR
Kombila
Maryvonne
M
Agbenyega
Tsiri
T
Bojang
Kalifa
K
Dietz
Klaus
K
Schmutzhard
Erich
E
Kremsner
Peter Gottfried
PG
D000293:Adolescent; D000818:Animals; D002648:Child; D002675:Child, Preschool; D005260:Female; D005681:Gabon; D005714:Gambia; D005869:Ghana; D006761:Hospitals; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007630:Kenya; D016778:Malaria, Falciparum / Q000175:diagnosis* / Q000473:pathology / Q000503:physiopathology*; D008295:Malawi; D008297:Male; D010963:Plasmodium falciparum / Q000302:isolation & purification; D011379:Prognosis; D012720:Severity of Illness Index