Imported severe malaria and risk factors for intensive care: A single-centre retrospective analysis

Abstract

Objectives: This study aims to identify the risk factors for intensive care (IC) in severe malaria patients admitted to the "Lazzaro Spallanzani" National Institute for Infectious Diseases, Rome, Italy.

Methods: All patients with confirmed severe malaria and hospitalized between 2007 and 2015 were included in the analysis and stratified into two groups: those requiring IC and those who did not. Five prognostic malaria scores were estimated; clinical severity at IC unit admission was assessed using the Sequential Organ Failure Assessment and the quick-Sequential Organ Failure Assessment scores. Univariate and multivariate analysis were performed to assess factors independently associated to IC.

Results: A total of 98 severe malaria patients were included; 10 of them required IC. There were no deaths or sequelae. Patients requiring IC had higher severity scores. At the multivariate analysis, only the number of World Health Organization criteria and the aspartate aminotransferase value were independently associated with the need of IC.

Conclusions: An early and accurate assessment of the severity score is essential for the management of severe malaria patients.

Fig 1. Malarial and non-malarial severity scores.

A positive linear regression was found between Sequential Organ Failure Assessment score (SOFA) and GCRBS Score (Glasgow coma scale, Creatinine, Respiratory rate, Bilirubin, Systolic blood pressure).

Fig 2

Aspartate aminotransferase levels (A) and N_WHO criteria (B) between ICU and non-ICU patients. Intensive Care Unit (ICU) group showed a significantly higher aspartate aminotransferase (AST) value (A) and higher number of WHO criteria (B) compared to non-ICU group.