title: Prognostic indicators in adults hospitalized with falciparum malaria in Western Thailand.
abstract: BACKGROUND
  Severe malaria remains a major cause of death and morbidity amongst adults in the Asiatic tropics.
  
  
  METHODS
  A retrospective analysis of the clinical and laboratory data of 988 adult patients, hospitalized with Plasmodium falciparum malaria and prospectively recruited to malaria studies in western Thailand between 1986 and 2002, was performed to assess the factors associated with a fatal outcome. Different severity scores and classifications for defining severe malaria were compared and, using multiple logistic regression, simple models for predicting mortality developed.
  
  
  RESULTS
  The proportion of patients fulfilling the WHO 2000 definition of severe malaria was 78.1%, and their mortality was 10%. Mortality in patients given parenteral artesunate or artemether (16/317, 5%) was lower than in those given parenteral quinine (59/442, 13%) (P < 0.001). Models using parameter sets based on WHO 1990, 2000 and Adapted AQ criteria plus blood smear parasite-stage assessment gave the best mortality prediction. A malaria prognostic index (MPI), derived from the dataset using five clinical or laboratory variables gave similar prognostic accuracy.
  
  
  CONCLUSIONS
  The mortality of severe malaria in adults has fallen and the switch from quinine to artesunate has probably been an important contributor. Prognostic indices based on WHO 2000 definitions, and other simpler indices based on fewer variables, provide clinically useful predictions of outcome in Asian adults with severe malaria.
authors.affiliation: Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR. paul@tropmedres.ac
authors.forename: Paul N
authors.initials: PN
authors.lastname: Newton
authors.forename: Kasia
authors.initials: K
authors.lastname: Stepniewska
authors.forename: Arjen
authors.initials: A
authors.lastname: Dondorp
authors.forename: Kamolrat
authors.initials: K
authors.lastname: Silamut
authors.forename: Wirongrong
authors.initials: W
authors.lastname: Chierakul
authors.forename: Sanjeev
authors.initials: S
authors.lastname: Krishna
authors.forename: Timothy M E
authors.initials: TM
authors.lastname: Davis
authors.forename: Yupin
authors.initials: Y
authors.lastname: Suputtamongkol
authors.forename: Brian
authors.initials: B
authors.lastname: Angus
authors.forename: Sasithon
authors.initials: S
authors.lastname: Pukrittayakamee
authors.forename: Ronnatrai
authors.initials: R
authors.lastname: Ruangveerayuth
authors.forename: Josh
authors.initials: J
authors.lastname: Hanson
authors.forename: Nicholas P J
authors.initials: NP
authors.lastname: Day
authors.forename: Nicholas J
authors.initials: NJ
authors.lastname: White
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D037621:Artemisinins / Q000627:therapeutic use; D000077332:Artesunate; D005260:Female; D006801:Humans; D016778:Malaria, Falciparum / Q000188:drug therapy / Q000401:mortality* / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011803:Quinine / Q000627:therapeutic use; D012720:Severity of Illness Index; D016019:Survival Analysis; D013785:Thailand; D055815:Young Adult
chemical_list: D037621:Artemisinins; D000077332:Artesunate; D011803:Quinine