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|Title: ||The Prognostic Value of Measures of Acid/Base Balance in Pediatric Falciparum Malaria, Compared with Other Clinical and Laboratory Parameters|
|Authors: ||Agbenyega, Edward Tsiri|
Newton, Charles R. J. C.
Taylor, Terrie E.
|Issue Date: ||19-Mar-2005|
|Publisher: ||Infectious Diseases Society of America|
|Citation: ||Infectious Diseases Society of America, 2005|
|Abstract: ||Identifying severe, life-threatening falciparum malaria in African children allows for the prompt
institution of appropriate management. In the past 2 decades, hyperlactatemia and acidosis have been identified
as being associated with mortality in patients with severe malaria, but measurement of blood lactate concentration
and base excess is expensive and technically demanding. In this large, prospective study, we examined the prognostic
value of acidosis and hyperlactatemia and compared these markers to clinically assessed variables.
Methods. We examined several clinical and laboratory measurements as prognostic markers of mortality in
14,605 parasitemic children admitted to 3 hospitals in Africa. Whole-blood lactate concentration and acid/base
status were used to identify subjects who had hyperlactatemia and acidosis.
Results. Using cut-points established by sensitivity and specificity curves, the sensitivities and positive predictive
values for both lactate concentration and base excess were low, the specificities were moderate, and the negative
predictive values were high (197%). No reliable clinical surrogates for hyperlactatemia or acidosis were identified.
Addition of lactate concentration and base excess to predictive models with previously identified clinical features
(Blantyre Coma Score, deep breathing, prostration, and weight-for-age Z score) and 1 laboratory measure (blood
glucose level) did not appreciably improve models to predict mortality.
Conclusions. Measurements of lactate concentration and acid/base balance are expensive to perform, and
performance of the latter can be problematic. Severe falciparum malaria may be readily recognized in children at
admission to hospitals in sub-Saharan Africa with use of simple, inexpensive means and does not require knowledge
of lactate concentration and base excess.|
|Description: ||This article is published at Infectious Diseases Society of America|
|Appears in Collections:||College of Health Sciences|
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