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Cardiac function in Ghanaian children with severe malaria
Samuel B Nguah1, Torsten Feldt, Steffi Hoffmann
1Department of Child Health, Komfo Anokye Teaching Hospital, Kumasi, Ghana.
Insights
In children with severe malaria, high cardiac output (CI) is linked to low hemoglobin, not metabolic acidosis. Parasite levels, however, significantly influence metabolic acidosis in severe malaria cases.
Area of Science:
- Pediatric infectious diseases
- Cardiovascular physiology in critical illness
- Malaria pathophysiology
Background:
- Severe malaria presents with complex physiological derangements.
- Cardiac dysfunction is a potential contributor to severe malaria symptoms, including metabolic acidosis.
- Understanding these relationships is crucial for managing pediatric severe malaria in endemic areas.
Purpose of the Study:
- To investigate the role of cardiac function in severe malaria symptoms, particularly metabolic acidosis, in children.
- To differentiate the etiological factors contributing to high cardiac output and metabolic acidosis in severe malaria.
Main Methods:
- A prospective observational study involving 183 children with severe malaria.
- Assessment of hemodynamic status and cardiac function using cardiac ultrasonography at admission and follow-up.
- Measurement of blood gas analyses, cardiac enzymes, and parasite levels to evaluate metabolic acidosis and cardiac function.
Main Results:
- Cardiac index (CI) was significantly elevated upon admission compared to recovery (P < 0.001).
- Increased CI correlated with lower hemoglobin levels but not with impaired tissue perfusion or metabolic acidosis.
- Parasite levels significantly influenced metabolic acidosis, whereas CI was not directly affected by parasite load. Findings were most pronounced in children under 2 years.
Conclusions:
- High output status (increased CI) in severe malaria is associated with anemia (low hemoglobin levels).
- Metabolic acidosis in severe malaria is primarily linked to parasite levels.
- Age is a significant factor, with younger children (<2 years) exhibiting more pronounced alterations.
Purpose:
The aim was to assess whether impaired cardiac function contributes to symptoms of severe malaria in general or to metabolic acidosis in particular in children living in endemic regions.
Methods:
In a prospective observational investigation, 183 children with severe malaria were investigated for hemodynamic status and cardiac function upon admission (day 0) and after recovery (day 42). Cardiac function parameters were assessed by cardiac ultrasonography. Blood gas analyses and cardiac enzymes were measured at hospitalization and follow-up. Differences in subgroups with and without metabolic acidosis as well as other severe malaria-defining symptoms and conditions were assessed.
Results:
Cardiac index (CI) was significantly increased on day 0 compared to day 42 (5.8 ml/m(2), SD ± 1.8 ml/m(2), versus 4.7 ml/m(2), SD ± 1.4 ml/m(2); P < 0.001). CI correlated negatively with hemoglobin levels but not with parameters indicating impaired tissue perfusion or metabolic acidosis. Parasite levels had a significant influence on metabolic acidosis but not on CI. Alterations related to cardiac function, hemoglobin levels and metabolic acidosis were most prominent in children younger than 2 years.
Conclusion:
Increased CI reflecting high output status is associated with low hemoglobin levels while metabolic acidosis is linked to parasite levels.
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