Anghan Hiren, Sethi Prayas, Soneja Manish, Mahajan Sandeep, Wig Naveet
Department of Medicine, All India Institute of Medical Sciences, New Delhi, India.
Department of Nephrology, All India Institute of Medical Sciences, New Delhi, India.
Indian J Crit Care Med. 2018 Oct;22(10):718-722. doi: 10.4103/ijccm.IJCCM_468_17.
Critically ill severe malaria constitutes one of the major hospital admissions in Indian setting. Clinical studies identifying the factors associated with acute kidney injury (AKI) in malaria are lacking. This study aimed to identify these factors.
This prospective observational study was conducted in a tertiary care center of North India. All adult patients with severe malaria were studied during 2012-2014.
The study included 79 patients and AKI was observed in 36 patients. Of these 79 patients, 52.7% were positive and 47.2% were positive. In AKI patients, thrombocytopenia and jaundice were the most common other complications seen. Among malarial patients, 17 (36%) patients had AKI. Features associated with AKI among patients admitted with malaria were as follows: tachycardia (adjusted relative risk [RR]: 3.9; 95% confidence interval [CI]: 1.1-13.7), direct hyperbilirubinemia (adjusted RR: 4.7; 95% CI: 1.4-15.2), anemia (adjusted RR: 6; 95% CI: 1.7-22.4), and sepsis (adjusted RR: 3.3; 95% CI: 1.1-13.7). The presence of tachycardia, acidosis, cerebral malaria, acute respiratory distress syndrome/acute lung injury, hypotensive shock, and poor Glasgow Coma Scale were associated with higher mortality in patients with AKI. Patients who required mechanical ventilation and/or vasopressor support had higher mortality.
is an important cause of severe malaria with AKI in our setting. Various other clinical features are associated with AKI and related mortality.
在印度，危重型重症疟疾是主要的住院病因之一。目前缺乏关于疟疾中与急性肾损伤（AKI）相关因素的临床研究。本研究旨在确定这些因素。
这项前瞻性观察性研究在印度北部的一家三级医疗中心进行。对2012年至2014年期间所有成年重症疟疾患者进行了研究。
该研究纳入了79例患者，其中36例观察到AKI。在这79例患者中，52.7% 呈 阳性，47.2% 呈 阳性。在AKI患者中，血小板减少和黄疸是最常见的其他并发症。在 疟疾患者中，17例（36%）有AKI。疟疾患者中与AKI相关的特征如下：心动过速（校正相对风险[RR]：3.9；95%置信区间[CI]：1.1 - 13.7）、直接胆红素血症（校正RR：4.7；95%CI：1.4 - 15.2）、贫血（校正RR：6；95%CI：1.7 - 22.4）和脓毒症（校正RR：3.3；95%CI：1.1 - 13.7）。心动过速、酸中毒、脑型疟疾、急性呼吸窘迫综合征/急性肺损伤、低血压休克和格拉斯哥昏迷评分低与AKI患者的较高死亡率相关。需要机械通气和/或血管升压药支持的患者死亡率更高。
在我们的研究环境中， 是重症疟疾合并AKI的重要原因。各种其他临床特征与AKI及相关死亡率有关。
