Krishnan Anand, Karnad Dilip R
Department of Medicine, Seth G.S. Medical College, Parel, Mumbai, India.
Crit Care Med. 2003 Sep;31(9):2278-84. doi: 10.1097/01.CCM.0000079603.82822.69.
To study the incidence and severity of multiple organ dysfunction in severe falciparum malaria.
Prospective, observational study.
Intensive care unit of a tertiary care university hospital.
Three hundred one consecutive patients with severe falciparum malaria admitted during the 30-month study period.
Daily assessment of clinical and biochemical variables required for calculating the Sequential Organ Failure Assessment (SOFA) score.
Central nervous system failure was present in 121 patients (53 deaths). Renal failure occurred in 91 patients (48 deaths), and 33 required dialysis. Severe thrombocytopenia occurred in 114 patients (seven required platelet transfusion), and 19 patients had thrombocytopenia and disseminated intravascular coagulation; all required component therapy; 229 patients received blood transfusion for severe hemolytic anemia. Hepatic failure occurred in 77 patients (38 deaths). Respiratory failure developed in 79 patients and carried the worst outcome (70 deaths). It occurred later in the course of the illness (mean, 3.1 days; p <.001) compared with cerebral, renal, and coagulation failure (mean, 1.3-2.3 days). Regardless of the organ system involved, only 11 of 172 patients with one or no organ failure died (6.8%), whereas mortality rate increased to 48.8% in 129 patients with multiple organ failure. Other abnormalities associated with poor outcome included seizures in 54 patients (56% mortality rate), metabolic acidosis in 167 (40% mortality rate), hypoglycemia in 88 (39% mortality rate), and hemoglobinuria in 190 (33% mortality rate). Sixty patients had quinine toxicity requiring dosage reduction. Bacterial sepsis occurred in 39 patients (35 deaths) and accounted for 85% of deaths occurring after day 7. Twenty-three pregnant women had no significant difference in outcomes. Overall mortality rate was 24.6% (301 patients, 74 deaths).
Malaria is an important cause of multiple organ failure in India. Mortality rate is 6.4% when one or fewer organs fail but increases to 48.8% with failure of two or more organs. However, outcomes are better than for similar degrees of organ failure in sepsis.
研究重症恶性疟原虫疟疾中多器官功能障碍的发生率和严重程度。
前瞻性观察性研究。
一所三级大学医院的重症监护病房。
在为期30个月的研究期间连续收治的301例重症恶性疟原虫疟疾患者。
每日评估计算序贯器官衰竭评估（SOFA）评分所需的临床和生化变量。
121例患者出现中枢神经系统衰竭（53例死亡）。91例患者发生肾衰竭（48例死亡），33例需要透析。114例患者出现严重血小板减少（7例需要输注血小板），19例患者同时有血小板减少和弥散性血管内凝血；所有患者均需要成分治疗；229例患者因严重溶血性贫血接受输血。77例患者出现肝功能衰竭（38例死亡）。79例患者发生呼吸衰竭，其预后最差（70例死亡）。与脑、肾和凝血功能衰竭（平均1.3 - 2.3天）相比，呼吸衰竭在病程后期出现（平均3.1天；p <.001）。无论涉及哪个器官系统，172例一个或没有器官衰竭的患者中只有11例死亡（6.8%），而129例多器官衰竭患者的死亡率升至48.8%。与预后不良相关的其他异常包括54例患者出现癫痫发作（死亡率56%）、167例患者出现代谢性酸中毒（死亡率40%）、88例患者出现低血糖（死亡率39%）以及190例患者出现血红蛋白尿（死亡率33%）。60例患者出现奎宁毒性需要减量。39例患者发生细菌败血症（35例死亡），占第7天之后死亡病例的85%。23例孕妇的结局无显著差异。总体死亡率为24.6%（301例患者，74例死亡）。
疟疾是印度多器官衰竭的重要原因。一个或更少器官衰竭时死亡率为6.4%，但两个或更多器官衰竭时死亡率升至48.8%。然而，其结局优于脓毒症中类似程度的器官衰竭。
