Table I.
Clinical and laboratory findings in children with Plasmodium falciparum malaria
| Comparison by severity (n = 1933) | Comparison by severe syndrome type (n = 850) | |||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Controls n = 1078 uncomplicated malaria (UM) | Cases n = 855 severe malaria (SM) | P value UM vs. SM | Severe malaria anaemia (SMA)* n = 522 | Isolated lactic acidosis (LA)† n = 154 | Cerebral malaria (CM)‡ n = 174 | |||||||
| n | n | n | n | n | P value SMA vs. non-SMA ¶ | |||||||
| Patient demographic factors: median, [IQR] or n (%) | ||||||||||||
| Age (years) | 2·9 [1·6–5·1] | 1078 | 1·8 [1·1–3·1] | 855 | <0·0001 | 1·6 [1·0–2·6] | 522 | 2·4 [1·2–3·9] | 154 | 2·51 [1·5–3·9] | 174 | <0·0001 |
| Body mass index | 15·4 [14·0–17·0] | 797 | 14·8 [13·6–16·5] | 655 | <0·0001 | 14·8 [13·6–16·2] | 414 | 15·2 [14·1–17·7] | 115 | 14·7 [13·3–16·7] | 122 | 0·086 |
| Sex (female: male) | 521:557 (48:52) | 1078 | 402:453 (47:53) | 855 | 0·60 | 242:280 (46:54) | 522 | 69:85 (45:55) | 154 | 90:84 (52:48) | 174 | 0·60 |
| Presence of HbS | 57 (6%) | 1045 | 43 (5%) | 826 | 0·89 | 30 (6%) | 505 | 7 (5%) | 149 | 6 (4%) | 167 | 0·33 |
| Malaria presentation features: median, [IQR] or n (%) | ||||||||||||
| Days unwell prior to hospitalization | 3 [2–4] | 1078 | 3 [3–5] | 855 | <0·0001 | 4 [3–5] | 522 | 3 [2–4] | 154 | 3 [3–4] | 174 | <0·0001 |
| Palpable spleen below costal margin (cm) | 0 | 674 | 2 [0–4] | 504 | <0·0001 | 3 [0–4] | 307 | 0·75 [0–3] | 108 | 2 [0–3] | 87 | 0·0002 |
| Haemoglobin (g/l) | 93 [82–104] | 1078 | 45 [36–63] | 855 | n/a | 38 [32–44] | 522 | 72 [59–87] | 154 | 69 [52–82] | 174 | n/a |
| SMA (%) | 0 | 1078 | 558 (65%) | 855 | n/a | 522 (100%) | 522 | 0 (0%) | 154 | 36 (21%) | 174 | n/a |
| MCV (fl) | 84 [78–89] | 1077 | 84 [78–90] | 855 | 0·61 | 85 [79–93] | 522 | 83 [78–88] | 154 | 84 [79–89] | 174 | 0·039 |
| Parasitized RBCs/μl | 83 000 [29 000–190 000] | 1063 | 91 100 [21 600-263 200] | 831 | 0·13 | 67 600 [14 800–191 800] | 503 | 187 000 [61 900–462 600] | 152 | 124 000 [25 600– 386 800] | 171 | <0·0001 |
| % RBCs parasitized | 2·2 [0·8–5·0] | 1062 | 4·6 [1·2–12·9] | 831 | <0·0001 | 4·2 [1·0–11·4] | 503 | 6·6 [2·4–14·3] | 152 | 4·6 [1·1–16·2] | 171 | 0·039 |
| Hyper-parasitaemia (>5% iRBC), (%) | 264 (25%) | 1063 | 402 (48%) | 831 | <0·0001 | 232 (46%) | 503 | 83 (54%) | 152 | 85 (50%) | 171 | 0·11 |
| Platelet count (×109/l) | 136 [81–217] | 1078 | 103 [60–170] | 854 | <0·0001 | 123 [79–181] | 522 | 78 [42–125] | 154 | 73 [43–130] | 174 | <0·0001 |
| Severe (<50 × 109/l) thrombocytopenia | 104 (10%) | 1078 | 166 (19%) | 854 | <0·0001 | 60 (11%) | 522 | 48 (31%) | 154 | 57 (33%) | 174 | <0·0001 |
| Leucocyte count (×109/l) | 7·8 [5·9–10·3] | 1072 | 11·1 [7·7–16·7] | 853 | <0·0001 | 12·6 [8·6–18·7] | 520 | 9·1 [6·6–11·5] | 154 | 9·4 [7·1–14·3] | 174 | <0·0001 |
| Absolute monocyte count (×109/l) | 0·5 [0·3–0·8] | 1065 | 0·8 [0·5–1·4] | 847 | <0·0001 | 1·0 [0·6–1·6] | 517 | 0·5 [0·3–0·9] | 154 | 0·6 [0·3–0·9] | 174 | <0·0001 |
| Lactate (mM) | 2·2 [1·6–3·0] | 1052 | 5·6 [3·1–8·3] | 851 | n/a | 4·8 [2·9–8·8] | 521 | 6·4 [5·7–8·0] | 154 | 4·3 [2·7–8·1] | 171 | 0·0045 |
| Patients with lactic acidosis (>5 mmol/l) (%) | 0 (0%) | 1052 | 482 (56%) | 851 | n/a | 248 (48%) | 521 | 154 (100%) | 154 | 80 (47%) | 171 | <0·0001 |
| Oximetry saturation (%) | 99 [97–100] | 1052 | 97 [94–99] | 849 | n/a | 97 [95–99] | 519 | 98 [96–99] | 154 | 96 [94–98] | 171 | 0·069 |
| Patients with hypoxia (SpO2 <90%) (%) | 0 (0%) | 1052 | 43 (5%) | 849 | n/a | 22 (4%) | 519 | 6 (4%) | 154 | 10 (6%) | 171 | 0·77 |
| Patients with respiratory distress (%) | 74 (7%) | 1078 | 518 (61%) | 855 | <0·0001 | 310 (59%) | 522 | 78 (51%) | 154 | 125 (72%) | 174 | 0·51 |
| Cerebral malaria (%) | 0 (0%) | 1078 | 174 (20%) | 855 | n/a | 0 (0%) | 522 | 0 (0%) | 154 | 174 (100%) | 174 | n/a |
| Deaths (%) | 0 (0%) | 1078 | 48 (4·5%) | 855 | n/a | 10 (1·9%) | 522 | 5 (3·3%) | 154 | 33 (19·0%) | 174 | <0·0001 |
| Host phenotypes for receptors of parasite cytoadhesion ligands: median, [IQR] or n (%) | ||||||||||||
| Group A | 266 (24·7%) | 1077 | 252 (29·5%) | 854 | <0·0001 | 140 (26·8%) | 522 | 50 (32·7%) | 153 | 61 (35·1%) | 174 | 0·016 |
| Group AB | 36 (3·3%) | 65 (7·6%) | 49 (9·4%) | 5 (3·3%) | 10 (5·7%) | |||||||
| Group B | 238 (22·1%) | 190 (22·2%) | 122 (23·4%) | 33 (21·6%) | 34 (19·5%) | |||||||
| Group O | 537 (49·9%) | 347 (40·6%) | 211 (40·4%) | 65 (42·5%) | 69 (39·7%) | |||||||
| A1 positive (A1 or A1B) | 226 (90·0%) | 251 | 227 (92·3%) | 246 | 0·47 | 132 (88·6%) | 149 | 43 (100%) | 43 | 50 (96·2%) | 52 | 0·007 |
| A1 negative (non-A1 and non-A1B) | 25 (10·0%) | 19 (7·7%) | 17 (11·4%) | 0 (0%) | 2 (3·8%) | |||||||
| Monocyte CD54 MFI | 290 [189–404] | 1018 | 201 [118–298] | 805 | <0·0001 | 174 [98–264] | 495 | 286 [188–406] | 143 | 225 [135–311] | 162 | <0·0001 |
| Monocyte CD36 MFI | 216 [121–341] | 1031 | 134 [69–229] | 819 | <0·0001 | 135 [72–222] | 503 | 149 [72–271] | 147 | 112 [58–231] | 164 | 0·97 |
| Platelet CD36 MFI | 140 [82–215] | 1046 | 141 [80–208] | 828 | 0·79 | 129 [77–192] | 507 | 166 [100–243] | 149 | 146 [86–230] | 167 | 0·0009 |
UM, uncomplicated malaria; SM, severe malaria; IQR, interquartile range; MCV, mean corpuscular volume; RBC, red blood cell; iRBC, infected red blood cell; MFI, median fluorescence intensity; n/a Not applicable for comparison.
*
Severe Malaria Anaemia (SMA) with or without lactic acidosis but excluding cerebral malaria (CM).
†
Isolated Lactic Acidosis (LA) excludes SMA or CM.
‡
Cerebral Malaria (CM) includes all cases of CM with or without LA or SMA.
§
non-SMA refers to isolated LA combined with CM, as defined above.