Kremsner Peter Gottfried, Valim Clarissa, Missinou Michel A, Olola Christopher, Krishna Sanjeev, Issifou Saadou, Kombila Maryvonne, Bwanaisa Lloyd, Mithwani Sadik, Newton Charles R, Agbenyega Tsiri, Pinder Margaret, Bojang Kalifa, Wypij David, Taylor Terrie
Medical Research Unit, Albert Schweitzer Hospital, Lambaréné, Gabon.
J Infect Dis. 2009 Jan 1;199(1):142-50. doi: 10.1086/595295.
Plasmodium falciparum malaria is a common cause of morbidity in African children, but identifying those who are likely to die is problematic. Previous studies suggested that circulating malarial pigment might be a useful predictor of severity, but none were large enough to detect any association with mortality.
We used thick blood smears performed on admission for 26,296 children hospitalized with P. falciparum at 1 of 6 hospitals in the Severe Malaria in African Children network to assess the prognostic value of pigment-containing granulocytes, monocytes, and parasites.
Although at all but one of the study sites the risk of mortality for subjects presenting with >5 pigmented granulocytes per 200 white blood cells was higher than in subjects with no pigmented granulocytes, adjusted odds ratios estimated through logistic regression, which included other established markers of severe malaria, suggested that associations between pigmented cells and mortality were moderate to nonexistent in most sites. The predictive ability of pigmented cells was low, as measured by the change in the area under the receiver operating characteristic curve of logistic regression models.
Although high levels of pigmented cells were associated with a fatal outcome in some study sites, they were not useful predictors of outcome across Africa.
恶性疟原虫疟疾是非洲儿童发病的常见原因，但识别可能死亡的儿童存在问题。先前的研究表明，循环中的疟色素可能是严重程度的有用预测指标，但没有一项研究规模足够大，能够检测到与死亡率的任何关联。
我们对非洲儿童重症疟疾网络中6家医院之一收治的26296名因恶性疟原虫住院的儿童入院时所做的厚血涂片进行分析，以评估含色素的粒细胞、单核细胞和寄生虫的预后价值。
尽管在除一个研究地点外的所有地点，每200个白细胞中出现>5个含色素粒细胞的受试者的死亡风险高于无含色素粒细胞的受试者，但通过逻辑回归估计的调整比值比（其中包括其他已确定的重症疟疾标志物）表明，在大多数地点，含色素细胞与死亡率之间的关联为中度至不存在。通过逻辑回归模型的受试者工作特征曲线下面积变化衡量，含色素细胞的预测能力较低。
尽管在一些研究地点，高水平的含色素细胞与致命结局相关，但它们并非整个非洲有用的结局预测指标。
