Antunes Maria Lina, Seixas Jorge, Ferreira Humberto E, Silva Marcelo Sousa
Hospital Américo Boavida, Luanda 160963, Angola.
Global Health and Tropical Medicine R&D Center, NOVA University, 1349-008 Lisbon, Portugal.
J Clin Med. 2020 Nov 27;9(12):3862. doi: 10.3390/jcm9123862.
Severe malaria remains the primary cause of mortality in several African countries, including Angola, where severe malaria patient admission into intensive care units (ICU) is mandatory. The present observational and prospective study enrolled 101 consecutive severe malaria patients admitted at the ICU of Américo Boavida University Hospital (Luanda, Angola). Malaria was confirmed by microscopy and RDT, and WHO criteria were used to define severe malaria. The Sequential Organ Failure Assessment (SOFA) score was used to monitor organ dysfunctions. Surviving and nonsurviving patients were compared using bivariate statistical methods. Two-step cluster analysis was used to find discriminant organ dysfunctions that may correlate better with the observed mortality (16.8%), which was much lower than the one generated by the SOFA score. The study population was young, and 87% of the patients were local native residents. There was no statistically significant correlation between the parasitemia and the outcome. Hematological and cerebral dysfunctions were prevalent but were not discriminant when cluster analyses were performed to detect homogeneous subgroups of patients. In conclusion, the SOFA score was readily applicable and efficient in monitoring daily organ dysfunction but was not effective enough in predicting the outcome of severe malaria patients.
重症疟疾仍然是包括安哥拉在内的几个非洲国家的主要死因，在安哥拉，重症疟疾患者必须入住重症监护病房（ICU）。本观察性前瞻性研究纳入了101例连续入住阿梅里科·博阿维达大学医院（安哥拉罗安达）ICU的重症疟疾患者。通过显微镜检查和快速诊断检测确诊疟疾，并采用世界卫生组织标准定义重症疟疾。采用序贯器官衰竭评估（SOFA）评分来监测器官功能障碍。使用双变量统计方法对存活患者和非存活患者进行比较。采用两步聚类分析来寻找可能与观察到的死亡率（16.8%）相关性更好的判别性器官功能障碍，该死亡率远低于SOFA评分得出的死亡率。研究人群较为年轻，87%的患者为当地居民。疟原虫血症与结局之间无统计学显著相关性。血液学和脑功能障碍较为普遍，但在进行聚类分析以检测患者的同质亚组时，它们并无判别性。总之，SOFA评分在监测日常器官功能障碍方面易于应用且有效，但在预测重症疟疾患者的结局方面不够有效。
