Tangpukdee Noppadon, Elshiekh Sakhr Badawi Omar, Phumratanaprapin Weerapong, Krudsood Srivicha, Wilairatana Polrat
Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.
Southeast Asian J Trop Med Public Health. 2011 Nov;42(6):1305-12.
To identify factors associated with acute renal failure among patients with severe falciparum malaria (MARF), we studied 189 severe malaria patients admitted to the Hospital for Tropical Diseases, Faculty of Tropical Medicine, Mahidol University, in Bangkok, Thailand. Among these, 63 had MARF, and 126 did not. Baseline clinical demographics and laboratory variables were evaluated with univariate analysis. Logistic regression was used to ascertain adjusted odds ratios. By univariate analysis, factors associated with MARF included male gender, fever duration > 4 days, patients who lived in a non-endemic area prior to malaria infection, body mass index > 18.5 kg/m(2), oliguria, abdominal pain, impaired consciousness, jaundice, anemia, liver enlargement, total white blood cell count > 10x10(9)/1, total bilirubin > 3 mg/dl, aspartate aminotransferase > 120 U/l, alanine aminotransferase > 120 U/l, albumin < 3 g/dl, fever clearance time >72 hours, and parasite clearance time > 72 hours. A hemoglobin > 10 g/dl, patients living in a malaria endemic area, non-oliguria on the day of admission, and splenomegaly were negatively associated with MARF. After multivariate logistic regression, oliguria during the first 24 hours of admission and a history of living in a nonendemic area prior to malarial infection were factors associated with MARF. We conclude the most significant factors associated with MARF were oliguria on the day of admission and living in a non-endemic area prior to malaria infection.
为了确定重症恶性疟患者（MARF）急性肾衰竭的相关因素，我们研究了泰国曼谷玛希隆大学热带医学院热带病医院收治的189例重症疟疾患者。其中，63例患有MARF，126例未患。通过单因素分析评估基线临床人口统计学和实验室变量。采用逻辑回归确定调整后的比值比。单因素分析显示，与MARF相关的因素包括男性、发热持续时间>4天、疟疾感染前居住在非流行区的患者、体重指数>18.5 kg/m²、少尿、腹痛、意识障碍、黄疸、贫血、肝脏肿大、总白细胞计数>10×10⁹/L、总胆红素>3 mg/dl、天冬氨酸转氨酶>120 U/L、丙氨酸转氨酶>120 U/L、白蛋白<3 g/dl、热退时间>72小时以及寄生虫清除时间>72小时。血红蛋白>10 g/dl、居住在疟疾流行区的患者、入院当天无少尿以及脾肿大与MARF呈负相关。多因素逻辑回归分析后，入院后24小时内少尿以及疟疾感染前居住在非流行区的病史是与MARF相关的因素。我们得出结论，与MARF相关的最显著因素是入院当天少尿以及疟疾感染前居住在非流行区。
