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Randomized Controlled Trial
. 2021 Jun 25;20(1):282.
doi: 10.1186/s12936-021-03785-0.

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

Grace Mzumara  1   2   3   4 , Stije Leopold  5   6 , Kevin Marsh  5   7 , Arjen Dondorp  5   6 , Eric O Ohuma #  8   5   9 , Mavuto Mukaka #  10   8   5   6
Affiliations
Randomized Controlled Trial

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

Grace Mzumara et al. Malar J. .

Abstract

Background: Severe metabolic acidosis and acute kidney injury are major causes of mortality in children with severe malaria but are often underdiagnosed in low resource settings.

Methods: A 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.

Results: There 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) CONCLUSION: Clinical 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.

Keywords: Acute kidney injury; Africa; Metabolic acidosis; Plasmodium falciparum; Severe malaria.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Conceptual framework of features associated with severe metabolic acidosis and acute kidney injury in children with severe falciparum malaria [31]
Fig. 2
Fig. 2
Calibration plot of severe metabolic acidosis model
Fig. 3
Fig. 3
Calibration plot of uraemia model
See this image and copyright information in PMC

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References

    1. World malaria report 2018. Geneva: World Health Organization; 2018. Licence: CC BY-NC-SA 3.0 IGO. https://www.who.int/publications/i/item/9789241565653. Accessed 11 July 2019.
    1. Dondorp AM, Lee SJ, Faiz MA, Mishra S, Price R, Tjitra E, et al. The relationship between age and the manifestations of and mortality associated with severe malaria. Clin Infect Dis. 2008;47:151–157. doi: 10.1086/589287. - DOI - PubMed
    1. Kazembe LN, Kleinschmidt I, Sharp BL. Patterns of malaria-related hospital admissions and mortality among Malawian children : an example of spatial modelling of hospital register data. Malar J. 2006;5:93. doi: 10.1186/1475-2875-5-93. - DOI - PMC - PubMed
    1. Von SL, Olaosebikan R, Hendriksen ICE, Lee SJ, Adedoyin OT, Agbenyega T, et al. Predicting the clinical outcome of severe falciparum malaria in African children : findings from a large randomized trial. Clin Infect Dis. 2012;54:1080–1090. doi: 10.1093/cid/cis034. - DOI - PMC - PubMed
    1. Leopold SJ. Metabolomic characterization of acidosis in severe falciparum malaria. DPhil Thesis, University of Oxford; 2018. https://ora.ox.ac.uk/objects/uuid:3a089f85-39dc-478f-b627-37accb5004ea. Accessed 27 July 2019.

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