Table 1.
Clinical and laboratory characteristics on admission by in-hospital mortality at 72 h
| Survivors | Non-survivors | Total | Unadjusted OR of death (95% CI) | p valuea | |
|---|---|---|---|---|---|
| Number, N (%)b | 2699 (90) | 309 (10) | 3008 | – | – |
| General | |||||
| Female | 1240/2699 (46) | 147/309 (5) | 1387/3008 (46) | 1.07 (0.84, 1.35) | 0.59 |
| Age (months); median (IQR)c | 24 (14, 39) | 23 (11, 38) | 24 (13, 38.5) | – | 0.77d |
| Age < 12 months | 494/2699 (16) | 83/309 (3) | 577/3008 (19) | 1.64 (1.25, 2.15) | < 0.001 |
| Middle-arm circumference ≤ 11.5 cm | 56/2644 (1.95) | 13/199 (0.5) | 69/2843 (2.4) | 3.23 (1.73, 6) | < 0.001 |
| Axillary temperature > 39 °C | 658/2694 (22) | 45/309 (1) | 703/3003 (23) | 0.62 (0.44, 0.86) | < 0.01 |
| Hypothermia (temperature < 36 °C) | 133/2694 (4) | 53/309 (2) | 186/3003 (6) | 3.99 (2.82, 5.64) | < 0.001 |
| Respiratory | |||||
| Respiratory rate; median (IQR)c | 57 (48, 67) | 60 (50, 70) | 57 (48, 67) | – | 0.03d |
| Respiratory distress | 2183/2688 (73) | 280/308 (9) | 2463/2996 (82) | 2.31 (1.55, 3.46) | < 0.001 |
| Deep breathing | 1674/2697 (56) | 261/308 (8) | 1935/3005 (64) | 2.47 (1.95, 3.14) | < 0.001 |
| Hypoxaemia (oxygen saturation ≤ 90%) | 521/2626 (18) | 113/271 (4) | 634/2897 (22) | 2.89 (2.22, 3.76) | < 0.001 |
| Crackles on auscultation | 543/2697 (18) | 112 /308 (4) | 655/3005 (22) | 2.27 (1.76, 2.92) | < 0.001 |
| Cardiovascular | |||||
| Severe tachycardiae | 1955 /2697(73) | 165/308 (54) | 2120/3005 (71) | 0.44 (0.34, 0.56) | < 0.001 |
| Bradycardia | 15/2698 (0.6) | 2/3071 (7) | 36/3005 (1.2) | 13.13 (6.62, 26) | < 0.001 |
| Capillary refill time: | |||||
| < 2 s | 921/2696 (34) | 53/308 (17) | 974/3004 (32) | 1.00 (Ref.)f | |
| 2–3 s | 1130/2696 (42) | 109/308 (35) | 1239/3004 (41) | 2.50 (1.83, 3.40) | < 0.001 |
| ≥ 3 s | 645/2696 (24) | 146/308 (47) | 791/3004 (26) | 2.87 (2.25, 3.66) | < 0.001 |
| Lower limb temperature gradientg | 1544/2699 (57) | 233/309 (75) | 1777/3008 (59) | 2.29 (1.75, 3.01) | < 0.001 |
| Weak radial pulse | 486/2699 (18) | 149/309 (48) | 635/3008 (21) | 4.24 (3.30, 5.45) | < 0.001 |
| Moderate hypotensionh | 162/2664 (6) | 40/289 (14) | 202/2953 (7) | 2.48 (1.71, 3.60) | < 0.001 |
| Dehydration (sunken eyes or reduced skin turgor) | 178/2697 (7) | 51/307 (17) | 229/3004 (8) | 2.82 (2.01, 3.96) | < 0.001 |
| Neurological | |||||
| Level of consciousness: | |||||
| Alert | 657 /2696(24) | 22/309 (7) | 679/3005 (23) | 1.00 (Ref.)f | |
| Prostratei | 1714/2696 (64) | 171/309 (55) | 1885/3005 (63) | 2.98 (1.89, 4.69) | < 0.001 |
| Comaj | 325/2696 (12) | 116/309 (38) | 441/3005 (15) | 10.66 (6.63, 17.14) | < 0.001 |
| Convulsions in this illness | 301/2698 (11) | 48/309 (16) | 349/3007 (12) | 1.40 (1.00, 1.95) | 0.05 |
| Clinical anaemia | |||||
| Severe pallork | 969/2694 (36) | 170 /309(55) | 1139/3003 (38) | 2.18 (1.71, 2.77) | < 0.001 |
| Haemoglobinuria (history of dark urine) | 339/2694 (1.4) | 40/307 (13) | 379/3001 (13) | 1.21 (0.95, 1.54) | 0.13 |
| Jaundice | 833/2695 (31) | 133/309 (43) | 966/3004 (32) | 1.65 (1.30, 2.10) | < 0.001 |
| Laboratory tests | |||||
| Lactate (mmol/L); median (IQR)c | 3.4 (2.2, 6.9) | 10.9 (5.2, 13.6) | 3.8 (2.3, 8) | – | < 0.001d |
| Hyperlactataemia (lactate, mmol/L) | |||||
| No (< 2.5) | 856/2699 (32) | 25/309 (8) | 881/3008 (29) | 1.00 (Ref.)f | |
| Moderate (2.5–5) | 902/2699 (33) | 46/309 (15) | 948/3008 (32) | 1.75 (1.06, 2.87) | 0.03 |
| Severe (≥ 5) | 941/2699 (35) | 238/309 (77) | 1179/3008 (39) | 8.66 (5.6, 13.4) | < 0.001 |
| Severe acidaemia: | |||||
| pH < 7.2 | 138/1816 (8) | 70/208 (34) | 208/2024 (10) | 6.17 (4.35, 8.74) | < 0.001 |
| Base deficit > −8 mmol/L | 869/1809 (48) | 170/203 (84) | 1039/2012 (58) | 5.57 (3.76, 8.26) | < 0.001 |
| Bicarbonate < 15 mmol/L | 588/1808 (3) | 151/206 (73) | 739/2014(37) | 5.69 (4.07, 7.97) | < 0.001 |
| Haemoglobin (g/dL): | 2930 | ||||
| ≥ 10 | 648/2628 (25) | 42/302 (14) | 690/2930 (24) | 1.00 (Ref.)f | |
| 7 to < 10 | 720/2628 (27) | 80/302 (27) | 800/2930 (27) | 1.71 (1.16, 2.53) | < 0.01 |
| 5 to < 7 | 437/2628 (17) | 45/302 (15) | 482/2930 (16) | 1.59 (1.02, 2.46) | 0.04 |
| < 5 | 823 /2628(31) | 135/302 (45) | 958/2930 (33) | 2.53 (1.76, 3.64) | < 0.001 |
| Glucose (mmol/L); median (IQR)c | 6.9 (5.5, 8.70) | 5.95 (3.6, 9.1) | 6.9 (5.4, 8.7) | – | < 0.001d |
| Hypoglycaemia (glucose < 2.5 mmol/L) | 82/2615 (3) | 48 /300(16) | 130/915 (4) | 5.88 (4.00, 8.66) | < 0.001 |
| Blood urea nitrogen (BUN) ≥ 7.14 mmol/L | 337/1819 (19) | 90/205 (44) | 427/2024 (21) | 3.44 (2.54, 4.67) | < 0.001 |
| Hyperkalaemia (≥ 6 mmol/L) | 50/1768 (3) | 37 /197(19) | 87/1965 (4) | 7.90 (4.98, 12.7) | < 0.001 |
| Microbiology | |||||
| Malaria parasitaemia, positivel | 1571/2695 (58) | 148/307 (48) | 1719/3002 (57) | 0.67 (0.53, 0.84) | < 0.001 |
| HIV antibody, positive | 86/2197 (4) | 20/220 (9) | 106/2417(4) | 2.46 (1.48, 4.08) | < 0.001 |
| Blood culture, positive | 106/947 (11) | 17/105 (16) | 123 /1052 (12) | 1.53 (0.88, 2.68) | 0.13 |
aChi-squared test p values
bOf 3170 children enrolled in the FEAST trial, 162 did not have lactate measured at baseline
cIQR: percentile 25, percentile 75
dWilcoxon rank sum test p value
eSevere tachycardia was defined as > 180 beats per minute (bpm) in children < 12 months, > 160 bpm in children aged 12 months to 5 years, and > 140 bpm for those aged > 5 years
fRef: Reference group
gTemperature gradient was assessed by running the back of the hand from the toe to the knee; a positive temperature gradient was defined as a notable temperature change from cold (dorsum of foot) to warm (knee)
hModerate hypotension was defined as systolic blood pressure of 50–75 mmHg in children younger than 12 months, 60–75 mmHg in those 12 months to years, and 70–85 mmHg in those older than 5 years, as measured by automated blood pressure monitor
iProstration was defined as the inability of a child older than 8 months of age to sit upright or the inability of a child 8 months of age or younger to breast feed
jComa was defined as the inability to localise a painful stimulus
kPallor manifested in lips, gums, or inner eyelids
lPositive on quality-controlled malaria slide, or, if missing, on rapid diagnostic test