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Overview :
Blumberg et al identified risk factors associated with mortality
in patients with severe malaria in a non-endemic area. This can help identify
patients who may require more aggressive management and closer monitoring. The
authors are from the University of the Witwatersrand in South Africa.
Risk factors associated with mortality, based on admission to
the ICU:
(1) pregnancy (results in death both of the mother and
fetus)
(2) highest Apache II score in the first 24 hours (see also
previous section)
(3) highest arterial blood lactate level in the first 24
hours
(4) most negative base excess in the first 24 hours
The exact cutoff points were not specified. Based on the data
shown in Table 4, page 219, some possible cutoff points might be:
(1) Apache II > 23
(2) arterial blood lactate > 3 mmol/L
(3) negative base excess < -10 mmol/L
A high Apache II score reflected multi-organ failures. Patients
who died had high rates of:
(1) ARDS
(2) acute renal failure
(3) shock requiring inotropic support
Mortality was also associated with marked elevations of tumor
necrosis factor (TNF).
Most interestingly, the following factors were not found to be
predictive of mortality:
(1) admission hemoglobin
(2) admission platelet count
(3) admission parasite count
(4) minimum Glasgow Coma Score
The authors postulated that many patients with cerebral malaria
can recover if they receive proper critical care with preservation of the airway
and ventilatory support.
Limitations:
• The
methodology and normal reference ranges for arterial blood lactate and base
excess were not given.
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