Table 2.
Ability of clinical signs to identify hypovolaemia in adults with severe malaria
|
Clinical finding |
Hypovolaemic1 |
Euvolaemic1 |
PPV |
NPV |
Sensitivity |
Specificity |
|---|---|---|---|---|---|---|
| (95% CI) | (95% CI) | (95% CI) | (95% CI) | |||
| Dry mucous membranes |
235/324 |
42/65 |
85% |
21% |
73% |
35% |
| (80–89) |
(14–29) |
(68–78) |
(24–48) |
|||
| Dry axillae |
138/324 |
27/65 |
84% |
17% |
43% |
58% |
| (77–89) |
(12–23) |
(37–48) |
(46–71) |
|||
| Decreased tissue turgor |
12/324 |
7/65 |
63% |
16% |
4% |
89% |
| (38–84) |
(12–20) |
(2–6) |
(79–96) |
|||
| Prolonged capillary refill 2,3 |
28/307 |
1/53 |
97% |
16% |
9% |
98% |
| (82–100) |
(12–20) |
(6–13) |
(90–100) |
|||
| Tachycardia > 100 bpm3 |
127/308 |
16/53 |
89% |
17% |
41% |
70% |
| (82–93) |
(12–23) |
(36–47) |
(56–82) |
|||
| Tachycardia > 120 bpm3 |
28/308 |
2/53 |
93% |
15% |
9% |
96% |
| (78–99) |
(12–20) |
(6–13) |
(87–100) |
|||
| Low JVP4 | 101/303 | 18/64 | 85% |
18% |
33% |
72% |
| (77–91) | (14–24) | (28–39) | (59–82) |
PPV Positive predictive value, NPV Negative predictive value.
1 Hypovolaemic: global end diastolic volume index (GEDVI) <680 ml/m2, euvolaemic: GEDVI: 680–800 ml/m2.
2 Greater than 2 seconds.
3 Excluding patients receiving inotropic support.
4 JVP < 3-4 cm above the sternal angle with the patient at 45º.