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

Abstract

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...

Biomarkers and Prognostic Scoring in Cerebral Malaria

“…Neurological findings are usually symmetrical. Motor abnormalities such as 20 decerebrate rigidity, decorticate rigidity or opisthotonos can be found. Muscle tone and tendon reflexes increase.…”

Determine the correlation between malaria severity assessment score and duration of hospital stay in malaria patients at tertiary care centre

“…Malaria is the most important tropical disease accounts for mortality with WHO estimates of over million deaths around the world making an impact to society. [1]. This is attributed to various reasons such as differences in the healthcare system, socio-cultural background and ethnicity.…”