title: A simple score to predict the outcome of severe malaria in adults.
abstract: BACKGROUND
  World Health Organization treatment guidelines recommend that adults with severe malaria be admitted to an intensive care unit (ICU). However, ICU facilities are limited in the resource-poor settings where most malaria occurs. Identification of patients at greater risk of complications may facilitate their triage and resource allocation.
  
  
  METHODS
  With use of data from a trial conducted in Southeast Asia (n=868), a logistic regression model was built to identify independent predictors of mortality among adults with severe malaria. A scoring system based on this model was tested in the original dataset and then validated in 2 series from Bangladesh (n=188) and Vietnam (n=292).
  
  
  RESULTS
  Acidosis (base deficit) and cerebral malaria (measured as Glasgow Coma Score) were the main independent predictors of outcome. The 5-point Coma Acidosis Malaria (CAM) score was simply derived from these 2 variables. Mortality increased steadily with increasing score. A CAM score <2 predicted survival with a positive predictive value (PPV) of 95.8% (95% confidence interval [CI], 93%- 97.7%). Of the 14 of 331 patients who died with a CAM score <2, 11 (79%) had renal failure and death occurred late after hospital admission (median, 108 h; range, 40-360 h). Substitution of plasma bicarbonate as the measure of acidosis only slightly reduced the prognostic value of the model. Use of respiratory rate was inferior, but a score <2 still predicted survival with a PPV of 92.2% (95% CI, 89.1%-94.7%).
  
  
  CONCLUSIONS
  Patients with a CAM score <2 at hospital admission may be safely treated in a general ward, provided that renal function can be monitored.
authors.affiliation: Mahidol University, Bangkok, Thailand. drjoshhanson@gmail.com
authors.forename: Josh
authors.initials: J
authors.lastname: Hanson
authors.forename: Sue J
authors.initials: SJ
authors.lastname: Lee
authors.forename: Sanjib
authors.initials: S
authors.lastname: Mohanty
authors.forename: M A
authors.initials: MA
authors.lastname: Faiz
authors.forename: Nicholas M
authors.initials: NM
authors.lastname: Anstey
authors.forename: Prakaykaew
authors.initials: P
authors.lastname: Charunwatthana
authors.forename: Emran Bin
authors.initials: EB
authors.lastname: Yunus
authors.forename: Saroj K
authors.initials: SK
authors.lastname: Mishra
authors.forename: Emiliana
authors.initials: E
authors.lastname: Tjitra
authors.forename: Ric N
authors.initials: RN
authors.lastname: Price
authors.forename: Ridwanur
authors.initials: R
authors.lastname: Rahman
authors.forename: Francois
authors.initials: F
authors.lastname: Nosten
authors.forename: Ye
authors.initials: Y
authors.lastname: Htut
authors.forename: Gofranul
authors.initials: G
authors.lastname: Hoque
authors.forename: Tran Thi
authors.initials: TT
authors.lastname: Hong Chau
authors.forename: Nguyen
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authors.lastname: Hoan Phu
authors.forename: Tran Tinh
authors.initials: TT
authors.lastname: Hien
authors.forename: Nicholas J
authors.initials: NJ
authors.lastname: White
authors.forename: Nicholas P J
authors.initials: NP
authors.lastname: Day
authors.forename: Arjen M
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authors.lastname: Dondorp
mesh_terms: D000138:Acidosis / Q000473:pathology; D000328:Adult; D001459:Bangladesh; D003128:Coma / Q000473:pathology; D005260:Female; D006801:Humans; D008288:Malaria / Q000175:diagnosis* / Q000401:mortality / Q000473:pathology*; D008297:Male; D011379:Prognosis; D012720:Severity of Illness Index; D014744:Vietnam