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Blood glucose and prognosis in children with presumed severe malaria: is there a threshold for 'hypoglycaemia'?

Merlin L Willcox1, Mathieu Forster, Moussa I Dicko

  • 1Department of Primary Health Care, University of Oxford, Oxford, UK. merlinwillcox@doctors.org.uk

Tropical Medicine & International Health : TM & IH
|December 8, 2009
PubMed

Insights

Severe malaria in children is linked to blood glucose levels. Higher blood glucose, even above the current definition of hypoglycemia, is associated with better survival rates in pediatric severe malaria cases.

Area of Science:

  • Pediatric infectious diseases
  • Malaria research
  • Metabolic complications in critical illness

Background:

  • Hypoglycaemia (glucose <2.2 mmol/l) is a known complication of severe malaria in children.
  • The prognostic significance of other blood glucose levels in pediatric severe malaria remains understudied.

Purpose of the Study:

  • To investigate the association between various blood glucose levels and case fatality in children with severe malaria.
  • To determine if the current definition of hypoglycaemia accurately reflects prognosis in pediatric severe malaria.

Main Methods:

  • Prospective study of 437 children with presumed severe malaria in Mali.
  • Categorization of glycaemia: hypoglycaemia (<2.2 mmol/l), low glycaemia (2.2-4.4 mmol/l), normal glycaemia (4.4-8.3 mmol/l), and hyperglycaemia (>8.3 mmol/l).
  • Analysis of glycaemia and case fatality using logistic regression and receiver operator curve (ROC) analysis in 418 children.

Main Results:

  • Significant difference in blood glucose levels between non-survivors (median 4.6 mmol/l) and survivors (median 7.6 mmol/l).
  • Case fatality decreased with increasing blood glucose levels: 61.5% in hypoglycaemic children to 7.6% in hyperglycaemic children (P < 0.001).
  • Hypoglycaemia and low glycaemia significantly increased odds of death, while hyperglycaemia reduced them. ROC analysis identified a glycaemia threshold <6.1 mmol/l as predictive of death.

Conclusions:

  • The current definition of hypoglycaemia (glucose <2.2 mmol/l) may not represent the optimal threshold for predicting poor prognosis in pediatric severe malaria.
  • Higher blood glucose levels, including those previously considered normal or even hyperglycaemic, are associated with improved survival in children with severe malaria.
Abstract

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