A Simple Score to Predict the Outcome of Severe Malaria in Adults

Hanson, Josh; Lee, Sue J.; Mohanty, Sanjib; Faiz, M. Abul; Anstey, Nicholas M.; Charunwatthana, Prakay kaew; Yunus, Emran Bin; Mishra, Saroj K.; Tjitra, Emiliana; Price, Ric N.; Rahman, Ridwanur; Nosten, François; Htut, Ye; Hoque, Gofranul; Chau, Tran Thi Hong; Phu, Nguyen Hoan; Hien, Tran Tinh; White, Nicholas J.; Day, Nicholas P. J.; Dondorp, Arjen M.

doi:10.1086/649928

Cited by 87 publications

(96 citation statements)

References 35 publications

(56 reference statements)

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“…A PPV of 73.9% and negative predictive value of 100% denoted that the predictive value of survival in patients with low CAM scores was accurate rather than assessing the morbidity and mortality events in patients with CAM scores ≥2. Our study results are in accordance with the study of Hanson et al [8]; in that study, out of the 789 patients in SEAQUAMAT for whom the CAM score was calculated, 206 (26.10%) patients succumbed to death. Out of these, only 8 patients had a low CAM score, indicating the mortality events increased with the CAM scores.…”

Section: Discussionsupporting

confidence: 93%

“…Further, 6 (75%) patients among these 8 patients had renal failure; and only 1 patient out of these 6 patients was able to receive dialysis. Pregnancy was a risk factor for 1 patient among the 2 patients without renal failure; there were no additional risk factors identified during hospital admission for the other patients [8]. Similar results were obtained in the validation series conducted in Bangladesh and Vietnam [10,11].…”

Section: Discussionsupporting

confidence: 74%

“…Hanson et al [8], in 2009, proposed the idea of CAM scores, a 5 point scoring system, using GCS and base deficit marking for cerebral malaria and metabolic acidosis, respectively. By using the data from the South East Asian Quinine Artesunate Malaria Trial (SEAQUAMAT) study (the largest ever clinical trial involving adults with severe malaria), a logistic regression model was built to identify independent predictors of mortality among adults with severe malaria [9].…”

Section: Discussionmentioning

confidence: 99%

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Role of Coma Acidosis Malaria Score in Patients with Severe Malaria among Indian Population: a Tertiary Care Center Experience

et al. 2017

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Objective: Malaria is a prime public health threat in developing countries like India. There is an unmet need of a simplified methodology for the purpose of triage and provision of intensive care to the severely infected patients in these areas. Materials and Methods:We did a prospective study in patients (n=60) admitted with severe malaria in a single tertiary care center in the state of Haryana, India. We assessed the role of coma acidosis malaria (CAM) score in these patients when predicting mortality and morbidity events. Stepwise logistic regression analysis was applied to identify patients requiring intensive care based on the CAM score, and the prediction value of the scoring system was assessed among these patients.Results: Cerebral malaria (measured using the Glasgow coma scale) and acidosis (base deficit) were the major determinants of the CAM score. Serum bicarbonate levels and respiratory rates were assessed as the proxy markers of the base deficit as it is not always available. Morbidity increased steadily as the CAM scores increased. Sensitivity and negative predictive value of 100% depicted that the scoring system was able to identify patients who needed intensive care and accurately exclude the patients who could be conservatively managed in the ward. Positive predictive values of 73.9%, 68%, and 80.9% indicated that CAM, bicarbonatebased CAM (BCAM), and respiratory rate-based CAM (RCAM) scores, respectively, could precisely predict the morbidity and mortality events among patients with CAM scores ≥2. Conclusion:CAM scores have precise predictive values in assessing patients with severe malaria. The scoring system helps in accurate and systemic triage of patients, irrespective of species, and directs the treating physicians toward vigilant treatment and emergency care. Keywords: Emergency medicine, infectious diseases, internal medicine ÖZAmaç: Malarya Hindistan gibi gelişen ülkelerde önemli bir halk sağlığı sorunudur. Bu bölgelerde ağır bir şekilde enfekte olmuş hastalara triaj ve yoğun bakım sağlanması için basitleştirilmiş bir yönteme ihtiyaç vardır. Gereç ve Yöntemler:Hindistan'ın Haryana eyaletinde tek bir üçüncü derece sağlık bakımı merkezine baş-vuran ağır malaryalı hastalarda (n=60) prospektif bir çalışma yaptık. Bu hastalarda mortalite ve morbiditeyi tahmin etmede Koma Asidoz Malarya (CAM) skorunun rolü değerlendirildi. CAM skoruna dayanarak yoğun bakım gereken hastaları belirlemek için aşamalı lojistik regresyon analizi uygulandı ve bu hastalarda skorlama sisteminin tahmin değeri değerlendirildi.Bulgular: Serebral malarya (Glaskow Koma Ölçeği ile ölçüldüğü gibi) ve asidoz (baz açığı) CAM skorunun başlıca belirleyici faktörleriydi. Serum bikarbonat ve solunum sayısı, baz açığı her zaman mevcut olmadığından dolayı, baz açığının proxy belirteçleri olarak değerlendirildiler. Morbidite, CAM skorları arttıkça sabit olarak yükseldi. Sensitivite ve %100 negatif prediktif değer skorlama sisteminin yoğun bakıma ihtiyaç duyan hastaları belirleyebildiğini ve klinikte geleneksel yollarla yön...

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Section: Discussionsupporting

confidence: 93%

Section: Discussionsupporting

confidence: 74%

Section: Discussionmentioning

confidence: 99%

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Role of Coma Acidosis Malaria Score in Patients with Severe Malaria among Indian Population: a Tertiary Care Center Experience

et al. 2017

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“…CM often begins with generalized convulsions followed by loss of consciousness lasting for at least 30 minutes. Other neurological signs may be divergence of eyes, bruxism, different postures (like neck hyperextension), decortication and decerebration [8].…”

Section: Introductionmentioning

confidence: 99%

“…Nuchal rigidity and focal neurological signs are rare. Occurrence of the CM and its association with renal failure and/or metabolic acidosis lead to outcome deterioration [8]. Moreover, this pathology can be fatal within a few hours due to coma development, therefore being a medical emergency.…”

Section: Introductionmentioning

confidence: 99%

Epidemiological, clinical and therapeutic aspects of cerebral malaria imported in Albania

Ndreu

Hajdari

Ndoni

et al. 2016

J Infect Dev Ctries

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This is a case-report of two patients with cerebral malaria (CM) imported from West-African countries. Notably, this form of malaria was developed as a second disease episode, while the first episode was experienced in West Africa. These findings suggest that the second episode of malaria was caused by a different strain of Plasmodium falciparum as compared to the first one. They are the first cerebral malaria cases imported in Albania after the eradication and absence of Plasmodium for five decades. Early treatment of cerebral malaria is decisive on the duration of coma and disease's outcome.

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Treatment of Severe Malaria

Kurth¹

2019

Encyclopedia of Malaria

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A Simple Score to Predict the Outcome of Severe Malaria in Adults

Abstract: Patients with a CAM score <2 at hospital admission may be safely treated in a general ward, provided that renal function can be monitored.

Cited by 87 publications

References 35 publications

Role of Coma Acidosis Malaria Score in Patients with Severe Malaria among Indian Population: a Tertiary Care Center Experience

Role of Coma Acidosis Malaria Score in Patients with Severe Malaria among Indian Population: a Tertiary Care Center Experience

Epidemiological, clinical and therapeutic aspects of cerebral malaria imported in Albania

Treatment of Severe Malaria

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