Malaria Severity Score in Malaria Patients Admitted in Critical Care Wards

Abstract

Introduction: Prognostic scoring system in Intensive Care Unit (ICU) can be generic, which can be applied to any critical illness for which patients are admitted in critical wards or can be disease specific. Malaria Severity Score (MSS) is a disease specific prognostic scoring system. Aim: To study the role of MSS in patients having malaria who were critically ill having multi organ dysfunction and to correlate the score with risk of mortality. Materials and Methods: This longitudinal study was conducted at the Department of General Medicine, SBKSMI & RC, Sumandeep Vidyapeeth, Vadodara, Gujarat, India. Adult patients (>18 years) with falciparum as well as vivax malaria, who had positive peripheral smear malaria and were admitted in ICU/Casualty (Emergency) ward, were taken in the study. The score was calculated on day of admission, day 2 and day 7. The score was analysed between two groups: survivors and nonsurvivors. Appropriate statistical tests were applied (z-test for two population proportion and Chi-square test for categorical values). The p-value <0.05 was considered as significant. Results: Out of 60 patients, 41 survived and 19 died due to malaria. Mean age of survivors was 38.56±2.27 and of nonsurvivors 40.21±5.6 years (p=0.718). There were 27 patients of P.vivax, 30 of P. falciparum and three patients of mixed infection; mortality was in 09, 08, 02 patients, respectively. On admission, out of total 60 patients, 10 (16.67%) had 1+, 20 (33.33%) had 2+, 24 (40%) had 3+ and 6 (10%) had 4+ parasite count. There were no patients in 1+ parasite count group, two (10%) in 2+, eleven (45.8%) in 3+ and six (100%) in 4+ parasite count group. Mean MSS was not significantly different on day 0 and day 2 but was higher on day 7 in non-survivor group than in survivors group (p=0.005). Mortality prediction score cut-off was ≥9, which was obtained by plotting Receiver Operating Characteristic (ROC) curve. Mean MSS in non-survivor group was 7.37 on day 0, 6.58 on day 2 and 9.11 on day 7. Thus, MSS score of day 7 gave `prediction reaching cut-off value of ≥9. Conclusion: MSS was found to be a useful prognostic score in severe falciparum/vivax malaria who needs intensive care treatment as sequential score gives significant difference in survivors and non-survivors on seventh day.

Keywords

• falciparum malaria
• organ dysfunction
• prognostic scoring system
• vivax malaria