Clinical and laboratory predictors of death in African children with features of severe malaria: a systematic review and meta-analysisReportar como inadecuado

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BMC Medicine

, 15:147

First Online: 03 August 2017Received: 07 March 2017Accepted: 30 June 2017


BackgroundThe criteria for defining severe malaria have evolved over the last 20 years. We aimed to assess the strength of association of death with features currently characterizing severe malaria through a systematic review and meta-analysis.

MethodElectronic databases Medline, Embase, Cochrane Database of Systematic Reviews, Thomson Reuters Web of Knowledge were searched to identify publications including African children with severe malaria. PRISMA guidelines were followed. Selection was based on design epidemiological, clinical and treatment studies, setting Africa, participants children < 15 years old with severe malaria, outcome survival-death rate, and prognostic indicators clinical and laboratory features. Quality assessment was performed following the criteria of the 2011 Quality Assessment of Diagnostic Accuracy Studies QUADAS-2. Odds ratios ORs were calculated for each study and prognostic indicator, and, when a test was assessed in at least two studies, pooled estimates of ORs were computed using fixed- or random-effects meta-analysis.

ResultsA total of 601 articles were identified and screened and 30 publications were retained. Features with the highest pooled ORs were renal failure 5.96, 95% CI 2.93–12.11, coma score 4.83, 95% CI 3.11–7.5, hypoglycemia 4.59, 95% CI 2.68–7.89, shock 4.31, 95% CI 2.15–8.64, and deep breathing 3.8, 95% CI 3.29–4.39. Only half of the criteria had an OR > 2. Features with the lowest pooled ORs were impaired consciousness 0.58, 95% CI 0.25–1.37, severe anemia 0.76, 95% CI 0.5– 1.13, and prostration 1.12, 95% CI 0.45–2.82.

ConclusionThe findings of this meta-analysis show that the strength of association between the criteria defining severe malaria and death is quite variable for each clinical and-or laboratory feature OR ranging from 0.58 to 5.96. This ranking allowed the identification of features weakly associated with death, such as impaired consciousness and prostration, which could assist to improve case definition, and thus optimize antimalarial treatment.

KeywordsSevere malaria Predictors Death Mortality Systematic review AbbreviationsBCSBlantyre Coma Scale

CIconfidence interval

ORsodds ratios

PRISMAPreferred Reporting Items for Systemic Reviews and Meta-Analyses

QUADASQuality Assessment of Diagnostic Accuracy Studies

SMACSevere Malaria in African Children

WHOWorld Health Organization

Electronic supplementary materialThe online version of this article doi:10.1186-s12916-017-0906-5 contains supplementary material, which is available to authorized users.

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Autor: Paulina Sypniewska - Jose F. Duda - Isabella Locatelli - Clotilde Rambaud Althaus - Fabrice Althaus - Blaise Genton


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