title: Hemoglobin concentration and parasitemia on hospital admission predict risk of multiple organ dysfunction syndrome among adults with malaria.
abstract: Risk factors for progression from acute malaria to multiple organ dysfunction syndrome (MODS) are poorly understood. The MODS is commonly diagnosed with the sequential organ failure assessment (SOFA) scale, but this scale has been understudied in patients with severe malaria. We conducted a cohort study among 426 adult males admitted to hospital with malaria in Bogotá, Colombia. We estimated SOFA scores and relative risks (RRs) for MODS during hospitalization according to patients' characteristics on admission. Risk of MODS was 7.3% over a median 6.0 days in hospital. Baseline hemoglobin was strongly, inversely associated with MODS (adjusted RR for hemoglobin ≤ 8.5 g/dL versus hemoglobin > 11 g/dL = 9.5, 95% confidence interval [CI]: 3.6, 25.3). Plasmodium falciparum malaria and parasitemia were positively associated with MODS. There was a strong interaction between baseline parasitemia and hemoglobin on MODS risk. In conclusion, the use of parasitemia and hemoglobin on admission to identify high-risk patients deserves consideration.
authors.affiliation: University of Michigan School of Public Health, Department of Epidemiology, Ann Arbor, Michigan; Central Military Hospital, Department of Critical Medicine, Bogotá, Colombia; University of La Sabana, Faculty of Medicine, Chia, Colombia.
authors.forename: Emily
authors.initials: E
authors.lastname: Walton
authors.affiliation: University of Michigan School of Public Health, Department of Epidemiology, Ann Arbor, Michigan; Central Military Hospital, Department of Critical Medicine, Bogotá, Colombia; University of La Sabana, Faculty of Medicine, Chia, Colombia.
authors.forename: Henry
authors.initials: H
authors.lastname: Oliveros
authors.affiliation: University of Michigan School of Public Health, Department of Epidemiology, Ann Arbor, Michigan; Central Military Hospital, Department of Critical Medicine, Bogotá, Colombia; University of La Sabana, Faculty of Medicine, Chia, Colombia villamor@umich.edu.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Villamor
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D015331:Cohort Studies; D003105:Colombia; D006454:Hemoglobins / Q000378:metabolism*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D016778:Malaria, Falciparum / Q000097:blood / Q000150:complications / Q000469:parasitology*; D008297:Male; D009102:Multiple Organ Failure / Q000097:blood / Q000209:etiology / Q000469:parasitology*; D018512:Parasitemia / Q000097:blood / Q000150:complications / Q000469:parasitology*; D010963:Plasmodium falciparum / Q000502:physiology; D012306:Risk
chemical_list: D006454:Hemoglobins