Blood glucose and prognosis in children with presumed severe malaria: is there a threshold for 'hypoglycaemia'?
OBJECTIVE
Hypoglycaemia (glucose <2.2 mmol/l) is a defining feature of severe malaria, but the significance of other levels of blood glucose has not previously been studied in children with severe malaria.


METHODS
A prospective study of 437 consecutive children with presumed severe malaria was conducted in Mali. We defined hypoglycaemia as <2.2 mmol/l, low glycaemia as 2.2-4.4 mmol/l and hyperglycaemia as >8.3 mmol/l. Associations between glycaemia and case fatality were analysed for 418 children using logistic regression models and a receiver operator curve (ROC).


RESULTS
There was a significant difference between blood glucose levels in children who died (median 4.6 mmol/l) and survivors (median 7.6 mmol/l, P < 0.001). Case fatality declined from 61.5% of the hypoglycaemic children to 46.2% of those with low glycaemia, 13.4% of those with normal glycaemia and 7.6% of those with hyperglycaemia (P < 0.001). Logistic regression showed an adjusted odds ratio (AOR) of 0.75 (0.64-0.88) for case fatality per 1 mmol/l increase in baseline blood glucose. Compared to a normal blood glucose, hypoglycaemia and low glycaemia both significantly increased the odds of death (AOR 11.87, 2.10-67.00; and 5.21, 1.86-14.63, respectively), whereas hyperglycaemia reduced the odds of death (AOR 0.34, 0.13-0.91). The ROC [area under the curve at 0.753 (95% CI 0.684-0.820)] indicated that glycaemia had a moderate predictive value for death and identified an optimal threshold at glycaemia <6.1 mmol/l, (sensitivity 64.5% and specificity 75.1%).


CONCLUSIONS
If there is a threshold of blood glucose which defines a worse prognosis, it is at a higher level than the current definition of 2.2 mmol/l.
Willcox
Merlin L
ML
Department of Primary Health Care, University of Oxford, Oxford, UK. merlinwillcox@doctors.org.uk
Forster
Mathieu
M
Dicko
Moussa I
MI
Graz
Bertrand
B
Mayon-White
Richard
R
Barennes
Hubert
H
D015415:Biomarkers / Q000097:blood; D001786:Blood Glucose / Q000032:analysis*; D002648:Child; D002675:Child, Preschool; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D007003:Hypoglycemia / Q000097:blood / Q000175:diagnosis / Q000469:parasitology*; D007223:Infant; D007231:Infant, Newborn; D008288:Malaria / Q000097:blood / Q000150:complications*; D008297:Male; D011379:Prognosis
D015415:Biomarkers; D001786:Blood Glucose