Table 3.
Measures associated with acute kidney injury
| Severe malarial anemia (n = 219) | Cerebral malaria (n = 260) | |||||
|---|---|---|---|---|---|---|
| No AKI (n = 164) | AKI (n = 55) | p value | No AKI (n = 147) | AKI (n = 113) | p value | |
| Demographics | ||||||
| Age, years | 2.8 (2.1, 4.2) | 3.2 (2.0, 4.9) | 0.375 | 3.6 (2.7, 5.4) | 3.2 (2.2, 4.5) | 0.014 |
| Sex, F % | 65 (39.6) | 21 (38.2) | 0.849 | 59 (40.1) | 48 (42.3) | 0.705 |
| Weight-for-age z score | − 1.5 (− 2.2, − 0.7) | − 1.8 (− 2.4, − 0.6) | 0.439 | − 1.0 (− 1.8, − 0.4) | − 1.4 (− 1.9, − 0.8) | 0.044 |
| Height-for-age z score | − 1.0 (− 1.8, − 0.3) | − 1.4 (− 2.6, − 0.5) | 0.119 | − 0.7 (− 1.3, 0.3) | − 1.0 (− 1.9, − 0.1) | 0.024 |
| Weight-for-height z score | − 0.9 (− 1.8, − 0.1) | − 0.9 (− 1.6, − 0.1) | 0.697 | − 1.0 (− 1.8, − 0.1) | − 1.0 (− 1.7, − 0.3) | 0.914 |
| HIV-infected, n (%) | 5 (3.1) | 1 (1.9) | 1.000 | 1 (0.7) | 4 (4.0) | 0.165 |
| Sickle cell disease (HbSS), n (%) | 17 (10.4) | 4 (7.3) | 0.605 | 1 (0.7) | 0 (0.0) | 0.380 |
| Admission characteristics | ||||||
| Symptoms | ||||||
| History of fever, days | 4 (3, 5) | 3 (2, 5) | 0.078 | 3 (2, 4) | 3 (2, 4) | 0.537 |
| Tea-colored urine, n (%) | 23 (14.0) | 15 (27.3) | 0.025 | 18 (12.2) | 27 (23.9) | 0.014 |
| Diarrhea, n (%) | 10 (6.1) | 6 (10.9) | 0.235 | 6 (4.1) | 6 (5.3) | 0.640 |
| Vomiting, n (%) | 74 (45.1) | 38 (69.1) | 0.002 | 60 (40.8) | 38 (33.6) | 0.236 |
| Clinical signs | ||||||
| Temperature, °C | 37.7 (37.0, 38.5) | 37.7 (36.7, 38.5) | 0.976 | 38.0 (36.9, 38.5) | 37.6 (37.0, 38.5) | 0.161 |
| Pulse, beats/min | 150 (137, 162) | 154 (138, 168) | 0.158 | 148 (128, 165) | 150 (135, 168) | 0.278 |
| Respiratory rate, breaths/min | 44 (36, 55) | 40 (35, 52) | 0.358 | 44 (34, 54) | 44 (36, 56) | 0.357 |
| Systolic blood pressure, mmHg | 90 (82, 100) | 90 (85, 100) | 0.708 | 96 (90, 105) | 96 (85, 104) | 0.409 |
| Blantyre coma score | 5 (5, 5) | 5 (5, 5) | – | 2 (1, 2) | 2 (1, 2) | 0.684 |
| Glasgow coma score | 15 (15, 15) | 15 (15, 15) | – | 7 (6, 8) | 7 (6, 8) | 0.760 |
| Severe dehydration, n (%)1 | 4 (2.4) | 3 (5.5) | 0.371 | 4 (2.7) | 3 (2.7) | 1.000 |
| Urine hemoglobin positive, n (%) | 10 (7.7) | 8 (19.5) | 0.032 | 14 (10.8) | 28 (33.7) | < 0.0001 |
| Hemoglobinuria, n (%) | 16 (9.8) | 13 (23.6) | 0.009 | 10 (6.9) | 21 (18.6) | 0.004 |
| Laboratory tests | ||||||
| Hemoglobin, g/dL | 4.0 (3.1, 4.6) | 3.8 (3.4, 4.3) | 0.942 | 7.2 (5.7, 9.0) | 6.0 (4.8, 7.9) | 0.0002 |
| Glucose, mmol/L | 6.8 (5.0, 8.2) | 5.3 (4.1, 7.2) | 0.002 | 6.9 (5.4, 9.6) | 6.1 (4.6, 4.6) | 0.032 |
| Lactate, mmol/L | 4.6 (2.8, 7.7) | 5.5 (3.6, 9.5) | 0.052 | 3.3 (2.0, 6.1) | 4.3 (2.8, 8.0) | 0.003 |
| WBC, × 103/μL | 11.2 (8.2, 15.7) | 12.3 (9.2, 22.3) | 0.117 | 8.3 (6.3, 12.3) | 10.8 (7.9, 17.4) | 0.0008 |
| Platelet, × 103/μL | 155 (95, 242) | 133 (82, 197) | 0.179 | 62 (35, 112) | 51 (33, 109) | 0.225 |
| Total bilirubin, mg/dL | 1.1 (0.6, 1.9) | 1.5 (0.9, 2.9) | 0.007 | 1.4 (0.8, 2.0) | 2.0 (1.0, 3.6) | 0.0001 |
| Lactate dehydrogenase (LDH), U/L | 728 (591, 879) | 990 (754, 1510) | < 0.00001 | 712 (537, 906) | 1090 (797, 1513) | < 0.00001 |
| Plasma albumin, g/dL | 2.6 (2.4, 3.0) | 2.6 (2.3, 3.2) | 0.737 | 2.6 (2.3, 3.0) | 2.7 (2.4, 2.9) | 0.467 |
| Sodium, mmol/L | 134 (132, 136) | 135 (132, 137) | 0.383 | 132 (128, 135) | 133 (129, 136) | 0.180 |
| Peripheral parasite density, parasites/uL | 34,680 (10,435, 133,980) | 40,070 (6085, 138,470) | 0.868 | 50,820 (13,910, 287,835) | 42,140 (8000, 249,560) | 0.338 |
| Plasma PfHRP2, ng/mL | 886 (326, 2344) | 1415 (382, 3453) | 0.151 | 2244 (655, 3965) | 4394 (2208, 7469) | < 0.00001 |
| Creatinine, mg/dL | 0.31 (0.26, 0.38) | 0.53 (0.48, 0.67) | < 0.00001 | 0.33 (0.29, 0.39) | 0.58 (0.49, 0.78) | < 0.00001 |
| BUN, mg/dL | 11 (8, 16) | 22 (15, 30) | < 0.00001 | 13 (10, 17) | 26 (18, 41) | < 0.00001 |
| Composite disease severity score | ||||||
| Number of severity criteria2 | 3 (2, 3) | 3 (2, 4) | 0.0029 | 4 (3, 4) | 4 (3, 5) | 0.0004 |
| Nephrotoxic medication history3 | ||||||
| NSAIDs4 | 12 (7.3) | 3 (5.5) | 0.224 | 15 (10.2) | 15 (13.3) | 0.442 |
| Gentamicin | 2 (1.2) | 1 (1.8) | 1.000 | 5 (3.4) | 5 (4.4) | 0.671 |
| Any nephrotoxic medication5 | 14 (8.5) | 4 (7.3) | 1.000 | 19 (12.9) | 19 (16.8) | 0.379 |
| Number of nephrotoxic medications6 | ||||||
| 0 | 148 (91.4) | 50 (92.6) | 0.835 | 127 (87.6) | 98 (82.9) | 0.569 |
| 1 | 13 (8.0) | 4 (7.4) | 17 (11.7) | 18 (16.2) | ||
| 2 | 1 (0.6) | 0 (0.0) | 1 (0.7) | 1 (0.9) | ||
Continuous measures presented as median (interquartile range) unless otherwise indicated. Continuous measures compared using the Wilcoxon rank-sum test. Count measures compared using the Pearson’s chi-square or Fisher’s exact, as appropriate
1Severe dehydration (n = 14) was identified by the presence of sunken eyes (n = 12) or decreased skin turgor (n = 4), hemoglobinuria defined as tea-colored urine on microscopy without red blood cells
2Number of WHO criteria for severe malaria present (description in Additional file 1: Table S1)
3AKI was retrospectively assessed on stored blood samples, and data on AKI was not available on admission
4Non-steroidal anti-inflammatory drug (NSAID), included ibuprofen (n = 5), acetylsalicylic acid (n = 5), and diclophenac (n = 35)
5NSAID or gentamicin
6Sum of ibuprofen, acetylsalicylic acid, diclophenac, and gentamicin