Table 1.
Characteristics of patients with severePlasmodium falciparumtreated at the ICU with conventional treatment alone or with adjunctive automated RBC exchange
| Conventional treatment (n = 8) | Adjunct RBC exchange (n = 5) | ||
|---|---|---|---|
|
Median Age in years (range) |
43 (1–64) |
54 (30–71) |
|
|
Sex (Male / female) |
7 / 1 |
4 / 1 |
|
|
Median days on ICU (range) |
6.5 (2–45) |
7 (2–81) |
|
|
Ethnicity |
Caucasian |
5 |
4 |
|
African |
2 |
- |
|
|
Middle East |
1 |
1 |
|
|
Area of Infection (n) |
Africa |
7 |
5 |
|
Other |
1 (Nicaragua) |
- |
|
|
Prophylaxis (n) |
Yes |
- |
- |
|
No |
5 |
4 |
|
|
Not determined |
3 |
1 |
|
|
Cerebral malaria (n) |
6 (75 %) |
3 (60 %) |
|
|
Parasitaemia >10 % (n) |
6 (75 %) |
5 (100 %) |
|
|
Mechanical ventilation (n) |
5 (63 %) |
2 (40 %) |
|
|
Acute renal failure1(n) |
4 (50 %) |
2 (40 %) |
|
|
Norepinephrine demand (n) |
4 (50 %) |
4 (80 %) |
|
|
Baseline laboratory parameters (median, range) |
Haemoglobin (g/dl) |
11.45 (4.9-16.1) |
8.3 (5.7-12.6) |
|
Platelets (G/l) |
28.5 (14–50) |
46 (15–82) |
|
|
Lactate (mmol/l) |
3.1 (2.2-5.02) |
5.1 (2.3-12.9) |
|
|
LDH (U/l) |
779 (278–1392) |
692.5 (340–1848) |
|
|
Blood glucose (mg/dl) |
123 (73–226) |
85 (82–267) |
|
|
Median APACHE II score (range) |
17 (10–29) |
26 (16–32) |
|
|
Median SAPS II (range) |
45 (34–93) |
61 (39–78) |
|
|
Treatment |
Quinine + clindamycin |
Quinine + clindamycin3 |
|
|
Total number of RBC exchanges (n) |
0 |
7 |
|
| ·Patients with 1 RBC exchange |
0 |
3 |
|
| ·Patients with 2 RBC exchanges |
0 |
2 |
|
|
Adverse Events (moderate or sever intensity) |
4 |
4 |
|
|
Adverse events related to RBC exchange |
- |
- |
|
| Unrelated adverse events | ARDS (n = 2) |
ARDS (n = 1) |
|
| Septic shock (n = 1) |
VAP (n = 1) |
||
| Retinopathy (n = 1) |
Fungal sepsis (n = 1) |
||
| Increase of intracranial pressure (n = 1) |
DIC (n = 1) |
||
| Pneumonia (n = 2) |
Death (n = 1) |
||
| Delirium (n = 2) |
|
||
| DIC (n = 2) | |||
1 Requiring renal replacement therapy; 2 Calculated after ICU admission within 24 hours; only applicable to adults; 3 Two patients initially received intra-rectal artesunate prior to referral; APACHE: acute physiology and chronic health evaluation; ARDS: acute respiratory distress; DIC: disseminated intravascular coagulation; ICU: intensive care unit; LDH: lactate dehydrogenase; RBC: red blood cell; SAPS: simplified acute physiology score; VAP: ventilator associated pneumonia.