背景:当前非流行地区的严重疟疾定义遵循WHO标准,主要针对疟疾流行地区的儿童,非流行地区的潜在错误分类病例。我们在我们的患者队列中评估了改良的严重疟疾分类标准的性能。
方法:分析了在非地方病环境(2005-2023年)中接受疟疾治疗的患者的队列研究。我们使用WHO2013标准将患者分为严重疟疾(SM),除了高寄生虫血症,其中应用了2%的阈值。当出现以下至少一种情况时,SM患者被区分为非常严重的疟疾(VSM):寄生虫血症>10%,肺水肿,意识受损,癫痫发作,肾功能衰竭,代谢性酸中毒或高乳酸血症,休克或低血糖。在患有SM且没有VSM标准的患者中,不太严重的疟疾(LSM)定义为:2-10%的寄生虫血症,高胆红素血症,虚脱,贫血或轻微出血。主要复合结局是死亡或需要挽救生命的干预,正如在三个比较组中分析的那样。次要结果是共感染的患病率。
结果:在506名疟疾患者中,176(34.8%)提交给SM。共有37名(7.3%)病人出现危及生命的情况,即死亡(n=4)和/或需要挽救生命的干预措施(n=34)。所有死亡事件和34种救生干预措施中的33种发生在VSM组。LSM组的患者没有出现任何危及生命的疾病。至于共感染,28例(5.5%)患者患有社区获得性共感染,组间无差异(p=0.763)。
结论:在评估非流行地区的疟疾患者时,严重性标准定义将受益于审查。在SM的范围内,重新分类为LSM的患者出现危及生命的疾病的风险较低,合并感染发生率较低,可从重症监护病房外的治疗和经验性抗生素的限制性使用中获益.
BACKGROUND: The current definition of severe malaria in non-endemic areas follows WHO criteria, which mainly target children in malaria-endemic areas, potentially misclassifying cases in non-endemic regions. We assessed the performance of a modified severe malaria classification criteria within our patient cohort.
METHODS: A cohort study of patients managed for malaria in a non-endemic setting (2005-2023) was analyzed. We classified patients into severe malaria (SM) using WHO 2013 criteria except for hyperparasitemia, where 2 % threshold was applied. Patients with SM were distinguished as very severe malaria (VSM) when presenting at least one of the following conditions: parasitemia >10 %, pulmonary edema, impaired consciousness, seizures, renal failure, metabolic acidosis or hyperlactatemia, shock or hypoglycemia. In patients with SM and no criteria for VSM, less severe malaria (LSM) was defined by: 2-10 % parasitemia, hyperbilirubinemia, prostration, anemia or minor bleeding. The primary composite outcome was death or the need for a life-saving intervention, as analyzed in the three comparative groups. Secondary outcome was the prevalence of co-infections.
RESULTS: Among 506 patients with malaria, 176 (34.8 %) presented with SM. A total of 37 (7.3 %) patients developed a life-threatening condition, namely death (n = 4) and/or the need for life-saving interventions (n = 34). All fatalities and 33 out of the 34 life-saving interventions occurred in the VSM group. Patients in LSM group did not develop any life-threatening conditions. As to co-infections, 28 (5.5 %) patients had a community-acquired co-infection, with no differences between groups (p = 0.763).
CONCLUSIONS: Severity criteria definitions would benefit from a review when assessing patients with malaria in non-endemic areas. Within the spectrum of SM, patients reclassified as LSM have a low risk of developing a life-threatening condition and present low co-infection incidence and could benefit from management out of intensive care units and a restrictive use of empirical antibiotics.