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Low plasma bicarbonate predicts poor outcome of cerebral malaria in Nigerian children
S Oguche1, S I Omokhodion, A A Adeyemo
1Department of Paediatrics, College of Medical Sciences, University of Maiduguri, Maiduguri, Nigeria.
Insights
In Nigerian children, metabolic acidosis and elevated creatinine levels at admission are key indicators of poor outcomes in cerebral malaria. Early detection and specialized care are crucial for improving survival rates in these critical cases.
Area of Science:
- Pediatrics
- Infectious Diseases
- Clinical Biochemistry
Background:
- Cerebral malaria is a severe, often fatal complication of Plasmodium falciparum malaria, particularly in Sub-Saharan Africa.
- Predicting outcomes in pediatric cerebral malaria is critical for timely intervention and resource allocation.
Purpose of the Study:
- To evaluate the predictive value of routine biochemical laboratory indices for cerebral malaria outcomes in Nigerian children.
- To identify specific biochemical markers associated with mortality and neurological sequelae.
Main Methods:
- A prospective study of 50 Nigerian children (9 months to 6 years) diagnosed with cerebral malaria.
- Analysis of routine biochemical parameters including creatinine, electrolytes, and acid-base balance upon hospital admission.
- Statistical analysis to determine the association between biochemical derangements and patient outcomes (recovery, sequelae, death).
Main Results:
- Metabolic acidosis (22%) and elevated plasma creatinine (20%) were significantly associated with poor outcomes (p < 0.05).
- Azotaemia (29%) and hyponatraemia (16%) were also observed but not significantly linked to outcome.
- Multivariate analysis confirmed metabolic acidosis and elevated creatinine as independent predictors of poor outcome.
Conclusions:
- Metabolic acidosis and elevated plasma creatinine at admission are significant independent predictors of poor outcomes in pediatric cerebral malaria.
- Prompt referral and specialized management are essential for critically ill children presenting with these biochemical derangements.
Abstract:
Malaria remains a major cause of morbidity and mortality in many sub Saharan countries and cerebral malaria is widely recognised as one of its most fatal forms. We studied the predictive value of routine biochemical laboratory indices in predicting the outcome of cerebral malaria in 50 Nigerian children ages 9 months to 6 years with cerebral malaria at the University College Hospital, Ibadan, Nigeria. Of the 50 children studied, 43 (68%) made a full recovery, 5 (105) developed neurological sequelae while 11(22%) died. Biochemical derangements observed among the children included azotaemia (29%), elevated plasma creatinine (20%), metabolic acidiosis (22%) and hyponatraemia (16%). Metabolic acidosis and elevated plasma creatinine on admission were significantly associated with a poor outcome (p < 0.05). Hyponatraemia and hypokalaemia were not significantly associated with outcome. On multivariated analysis, metabolic acidosis and elevated plasma creatinine on admission to hospital remained independent predictors of poor outcome after adjusting for other known risk factors. Patients with these findings require prompt referral for adequate treatment in centres equipped to manage such critically ill patients.
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