Blantyre Malaria Project, Kamuzu University of Health Sciences, Private Bag 360, Blantyre, Malawi.
St. George's University of London/University of Nicosia Medical School, Nicosia, Cyprus.
Malar J. 2022 Feb 22;21(1):60. doi: 10.1186/s12936-022-04080-2.
Cerebral malaria is still a major cause of death in children in sub-Saharan Africa. Among survivors, debilitating neurological sequelae can leave children with permanent cognitive impairments and societal stigma, resulting in taxing repercussions for their families. This study investigated the effect of delay in presentation to medical care on outcome in children with cerebral malaria in Malawi.
This retrospective study included participants enrolled in a longstanding study of cerebral malaria between 2001 and 2021 and considered coma duration prior to arrival at hospital (with or without anti-malarial treatment), HIV status, blood lactate levels at admission and age as factors that could affect clinical outcome. Outcomes were categorized as full recovery, sequelae at the time of discharge, or death. A multinomial regression was fit and run controlling for coma duration, HIV status, lactate levels and age, to determine the association between each explanatory variable and outcome.
A total of 1663 children with cerebral malaria, aged 6 months to 14 years were included. Longer coma duration (in hours) was associated with greater odds of developing sequelae (OR = 1.023, 95% CI 1.007-1.039, p = 0.006) but not death (OR = 1.00, 95% CI 0.986-1.015, p = 0.961). Younger age (in months) was also correlated with higher rates of sequelae, (OR = 0.990, 95% CI 0.983-0.997, p = 0.004) but not with increased mortality (OR = 0.998, 95% CI 0.993-1.003, p = 0.335). Blood lactate levels on admission were correlated with mortality (OR = 1.125, 95% CI 1.090-1.161, p < 0.001) but not associated with increased rates of sequelae (OR = 1.016, 95% CI 0.973-1.060, p = 0.475). Positive HIV status and treatment with an anti-malarial (artemisinin or non-artemisinin-based) prior to arrival at the hospital were not significantly associated with either adverse outcome.
In Malawian children with cerebral malaria, higher rates of sequelae were significantly associated with extended coma duration prior to admission and younger age. Mortality rates were correlated with increased lactate levels on admission. The differential effects of variables on clinical outcomes suggest that there may be different pathogenic pathways leading to sequelae and death. Actions taken by parents and health care professionals are critical in defining when patients arrive at hospital and determining their ultimate outcome.
在撒哈拉以南非洲，脑疟疾仍然是儿童死亡的主要原因。在幸存者中，致残性神经后遗症会导致儿童出现永久性认知障碍和社会耻辱，给他们的家庭带来沉重的影响。本研究旨在探讨马拉维儿童脑疟疾患者就诊时间延迟对预后的影响。
这是一项回顾性研究，纳入了 2001 年至 2021 年间一项长期脑疟疾研究中的参与者，并考虑了入院前昏迷持续时间（有无抗疟治疗）、艾滋病毒状态、入院时血乳酸水平和年龄等因素，这些因素可能影响临床结局。结局分为完全恢复、出院时出现后遗症或死亡。采用多项回归分析控制昏迷持续时间、艾滋病毒状态、乳酸水平和年龄，以确定每个解释变量与结局之间的关联。
共纳入 1663 例年龄在 6 个月至 14 岁之间的脑疟疾患儿。昏迷时间（小时）越长，发生后遗症的几率越高（OR=1.023，95%CI 1.007-1.039，p=0.006），但与死亡无关（OR=1.00，95%CI 0.986-1.015，p=0.961）。年龄越小（月）也与更高的后遗症发生率相关（OR=0.990，95%CI 0.983-0.997，p=0.004），但与死亡率增加无关（OR=0.998，95%CI 0.993-1.003，p=0.335）。入院时血乳酸水平与死亡率相关（OR=1.125，95%CI 1.090-1.161，p<0.001），但与后遗症发生率增加无关（OR=1.016，95%CI 0.973-1.060，p=0.475）。入院前接受抗疟药物（青蒿素或非青蒿素类）治疗和艾滋病毒阳性与不良结局均无显著相关性。
在马拉维患有脑疟疾的儿童中，较长的昏迷时间和较小的年龄与更高的后遗症发生率显著相关。死亡率与入院时乳酸水平升高相关。这些变量对临床结局的不同影响表明，可能存在导致后遗症和死亡的不同发病途径。父母和医疗保健专业人员的行动对患者何时到达医院并决定其最终结局至关重要。
