title: Predicting the clinical outcome of severe falciparum malaria in african children: findings from a large randomized trial.
abstract: BACKGROUND
  Data from the largest randomized, controlled trial for the treatment of children hospitalized with severe malaria were used to identify such predictors of a poor outcome from severe malaria.
  
  
  METHODS
  African children (<15 years) with severe malaria participated in a randomized comparison of parenteral artesunate and parenteral quinine in 9 African countries. Detailed clinical assessment was performed on admission. Parasite densities were assessed in a reference laboratory. Predictors of death were examined using a multivariate logistic regression model.
  
  
  RESULTS
  Twenty indicators of disease severity were assessed, out of which 5 (base deficit, impaired consciousness, convulsions, elevated blood urea, and underlying chronic illness) were associated independently with death. Tachypnea, respiratory distress, deep breathing, shock, prostration, low pH, hyperparasitemia, severe anemia, and jaundice were statistically significant indicators of death in the univariate analysis but not in the multivariate model. Age, glucose levels, axillary temperature, parasite density, heart rate, blood pressure, and blackwater fever were not related to death in univariate models.
  
  
  CONCLUSIONS
  Acidosis, cerebral involvement, renal impairment, and chronic illness are key independent predictors for a poor outcome in African children with severe malaria. Mortality is markedly increased in cerebral malaria combined with acidosis. Clinical Trial Registration. ISRCTN50258054.
authors.affiliation: Department of Global Health, Menzies School of Health Research, Casuarina, Northern Territory, Australia. lseidlein@gmail.com
authors.forename: Lorenz
authors.initials: L
authors.lastname: von Seidlein
authors.forename: Rasaq
authors.initials: R
authors.lastname: Olaosebikan
authors.forename: Ilse C E
authors.initials: IC
authors.lastname: Hendriksen
authors.forename: Sue J
authors.initials: SJ
authors.lastname: Lee
authors.forename: Olanrewaju Timothy
authors.initials: OT
authors.lastname: Adedoyin
authors.forename: Tsiri
authors.initials: T
authors.lastname: Agbenyega
authors.forename: Samuel Blay
authors.initials: SB
authors.lastname: Nguah
authors.forename: Kalifa
authors.initials: K
authors.lastname: Bojang
authors.forename: Jacqueline L
authors.initials: JL
authors.lastname: Deen
authors.forename: Jennifer
authors.initials: J
authors.lastname: Evans
authors.forename: Caterina I
authors.initials: CI
authors.lastname: Fanello
authors.forename: Ermelinda
authors.initials: E
authors.lastname: Gomes
authors.forename: Alínia José
authors.initials: AJ
authors.lastname: Pedro
authors.forename: Catherine
authors.initials: C
authors.lastname: Kahabuka
authors.forename: Corine
authors.initials: C
authors.lastname: Karema
authors.forename: Esther
authors.initials: E
authors.lastname: Kivaya
authors.forename: Kathryn
authors.initials: K
authors.lastname: Maitland
authors.forename: Olugbenga A
authors.initials: OA
authors.lastname: Mokuolu
authors.forename: George
authors.initials: G
authors.lastname: Mtove
authors.forename: Juliet
authors.initials: J
authors.lastname: Mwanga-Amumpaire
authors.forename: Behzad
authors.initials: B
authors.lastname: Nadjm
authors.forename: Margaret
authors.initials: M
authors.lastname: Nansumba
authors.forename: Wirichada Pan
authors.initials: WP
authors.lastname: Ngum
authors.forename: Marie A
authors.initials: MA
authors.lastname: Onyamboko
authors.forename: Hugh
authors.initials: H
authors.lastname: Reyburn
authors.forename: Tharisara
authors.initials: T
authors.lastname: Sakulthaew
authors.forename: Kamolrat
authors.initials: K
authors.lastname: Silamut
authors.forename: Antoinette K
authors.initials: AK
authors.lastname: Tshefu
authors.forename: Noella
authors.initials: N
authors.lastname: Umulisa
authors.forename: Samwel
authors.initials: S
authors.lastname: Gesase
authors.forename: Nicholas P J
authors.initials: NP
authors.lastname: Day
authors.forename: Nicholas J
authors.initials: NJ
authors.lastname: White
authors.forename: Arjen M
authors.initials: AM
authors.lastname: Dondorp
mesh_terms: D000349:Africa; D000962:Antimalarials / Q000008:administration & dosage*; D037621:Artemisinins / Q000008:administration & dosage*; D000077332:Artesunate; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007275:Injections, Intravenous; D016778:Malaria, Falciparum / Q000175:diagnosis* / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D008297:Male; D011379:Prognosis; D011803:Quinine / Q000008:administration & dosage*; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D000962:Antimalarials; D037621:Artemisinins; D000077332:Artesunate; D011803:Quinine