Risk factors associated with mortality, based on admission to the ICU:
(1) pregnancy (results in death both of the mother and fetus)
(2) highest Apache II score in the first 24 hours (see also previous section)
(3) highest arterial blood lactate level in the first 24 hours
(4) most negative base excess in the first 24 hours
The exact cutoff points were not specified. Based on the data shown in Table 4, page 219, some possible cutoff points might be:
(1) APACHE II > 23
(2) arterial blood lactate > 3 mmol/L
(3) negative base excess < -10 mmol/L
A high Apache II score reflected multi-organ failures. Patients who died had high rates of:
(1) ARDS
(2) acute renal failure
(3) shock requiring inotropic support
Mortality was also associated with marked elevations of tumor necrosis factor (TNF).
Most interestingly, the following factors were not found to be predictive of mortality:
(1) admission hemoglobin
(2) admission platelet count
(3) admission parasite count
(4) minimum Glasgow Coma Score
The authors postulated that many patients with cerebral malaria can recover if they receive proper critical care with preservation of the airway and ventilatory support.
Limitations:
• The methodology and normal reference ranges for arterial blood lactate and base excess were not given.
