Identifying prognostic factors of severe metabolic acidosis and uraemia in African children with severe falciparum malaria: a secondary analysis of a randomized trial

Malaria Journal

Kevin Marsh¹  Arjen Dondorp²  Stije Leopold²  Grace Mzumara³  Mavuto Mukaka⁴  Eric O. Ohuma⁵ 

[1] Centre for Tropical Medicine and Global Health, Oxford, UK;KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya;Centre for Tropical Medicine and Global Health, Oxford, UK;Mahidol-Oxford Tropical Medicine Research Unit, Bangkok, Thailand;Malawi Liverpool Wellcome Trust, Queen Elizabeth Central Hospital College of Medicine, P.O. Box 30096, Chichiri 3, Blantyre, Malawi;University of Malawi, College of Medicine, Blantyre, Malawi;University of Oxford, Oxford, UK;Centre for Tropical Medicine and Global Health, Oxford, UK;University of Malawi, College of Medicine, Blantyre, Malawi;University of Oxford, Oxford, UK;Centre for Tropical Medicine and Global Health, Oxford, UK;Mahidol-Oxford Tropical Medicine Research Unit, Bangkok, Thailand;University of Oxford, Oxford, UK;Centre for Tropical Medicine and Global Health, Oxford, UK;Maternal, Adolescent, Reproductive and Child Health (MARCH) Centre, School of Hygiene and Tropical Medicine (LSHTM), London, UK;

关键词: Severe malaria;    Metabolic acidosis;    Acute kidney injury;    Plasmodium falciparum;    Africa;   

DOI  :  10.1186/s12936-021-03785-0

来源: Springer

【 摘 要 】

BackgroundSevere metabolic acidosis and acute kidney injury are major causes of mortality in children with severe malaria but are often underdiagnosed in low resource settings.MethodsA retrospective analysis of the ‘Artesunate versus quinine in the treatment of severe falciparum malaria in African children’ (AQUAMAT) trial was conducted to identify clinical features of severe metabolic acidosis and uraemia in 5425 children from nine African countries. Separate models were fitted for uraemia and severe metabolic acidosis. Separate univariable and multivariable logistic regression were performed to identify prognostic factors for severe metabolic acidosis and uraemia. Both analyses adjusted for the trial arm. A forward selection approach was used for model building of the logistic models and a threshold of 5% statistical significance was used for inclusion of variables into the final logistic model. Model performance was assessed through calibration, discrimination, and internal validation with bootstrapping.ResultsThere were 2296 children identified with severe metabolic acidosis and 1110 with uraemia. Prognostic features of severe metabolic acidosis among them were deep breathing (OR: 3.94, CI 2.51–6.2), hypoglycaemia (OR: 5.16, CI 2.74–9.75), coma (OR: 1.72 CI 1.17–2.51), respiratory distress (OR: 1.46, CI 1.02–2.1) and prostration (OR: 1.88 CI 1.35–2.59). Features associated with uraemia were coma (3.18, CI 2.36–4.27), Prostration (OR: 1.78 CI 1.37–2.30), decompensated shock (OR: 1.89, CI 1.31–2.74), black water fever (CI 1.58. CI 1.09–2.27), jaundice (OR: 3.46 CI 2.21–5.43), severe anaemia (OR: 1.77, CI 1.36–2.29) and hypoglycaemia (OR: 2.77, CI 2.22–3.46)ConclusionClinical and laboratory parameters representing contributors and consequences of severe metabolic acidosis and uraemia were independently associated with these outcomes. The model can be useful for identifying patients at high risk of these complications where laboratory assessments are not routinely available.

【 授权许可】

CC BY