Severe imported falciparum malaria: a cohort study in 400 critically ill adults.
BACKGROUND
Large studies on severe imported malaria in non-endemic industrialized countries are lacking. We sought to describe the clinical spectrum of severe imported malaria in French adults and to identify risk factors for mortality at admission to the intensive care unit.


RESULTS
Retrospective review of severe Plasmodium falciparum malaria episodes according to the 2000 World Health Organization definition and requiring admission to the intensive care unit. Data were collected from medical charts using standardised case-report forms, in 45 French intensive care units in 2000-2006. Risk factors for in-hospital mortality were identified by univariate and multivariate analyses. Data from 400 adults admitted to the intensive care unit were analysed, representing the largest series of severe imported malaria to date. Median age was 45 years; 60% of patients were white, 96% acquired the disease in sub-Saharan Africa, and 65% had not taken antimalarial chemoprophylaxis. Curative quinine treatment was used in 97% of patients. Intensive care unit mortality was 10.5% (42 deaths). By multivariate analysis, three variables at intensive care unit admission were independently associated with hospital death: older age (per 10-year increment, odds ratio [OR], 1.72; 95% confidence interval [95%CI], 1.28-2.32; P = 0.0004), Glasgow Coma Scale score (per 1-point decrease, OR, 1.32; 95%CI, 1.20-1.45; P<0.0001), and higher parasitemia (per 5% increment, OR, 1.41; 95%CI, 1.22-1.62; P<0.0001).


CONCLUSIONS
In a large population of adults treated in a non-endemic industrialized country, severe malaria still carried a high mortality rate. Our data, including predictors of death, can probably be generalized to other non-endemic countries where high-quality healthcare is available.
Bruneel
Fabrice
F
Service de Reanimation, Centre Hospitalier de Versailles, Le Chesnay, France. fbruneel@ch-versailles.fr
Tubach
Florence
F
Corne
Philippe
P
Megarbane
Bruno
B
Mira
Jean-Paul
JP
Peytel
Eric
E
Camus
Christophe
C
Schortgen
Frederique
F
Azoulay
Elie
E
Cohen
Yves
Y
Georges
Hugues
H
Meybeck
Agnes
A
Hyvernat
Herve
H
Trouillet
Jean-Louis
JL
Frenoy
Eric
E
Nicolet
Laurent
L
Roy
Carine
C
Durand
Remy
R
Le Bras
Jacques
J
Wolff
Michel
M
D000328:Adult; D000368:Aged; D000962:Antimalarials / Q000627:therapeutic use; D015331:Cohort Studies; D016638:Critical Illness; D005260:Female; D006801:Humans; D016778:Malaria, Falciparum / Q000188:drug therapy / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012720:Severity of Illness Index
D000962:Antimalarials