Prognostic Value of Circulating Pigmented Cells in African Children with Malaria
Prognostic Value of Circulating Pigmented Cells in African Children with Malaria
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DOI：
10.1086/595295
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发表时间：
2009-01-01
影响因子：
6.4
通讯作者：
Taylor, Terrie
中科院分区：
文献类型：
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作者：
Kremsner, Peter Gottfried;Valim, Clarissa;Taylor, Terrie
背景恶性疟原虫疟疾是非洲儿童发病的常见原因，但确定那些可能死亡的人是有问题的。以前的研究表明，循环疟疾色素可能是一个有用的预测严重程度，但没有足够大的检测与死亡率的任何关联。我们对非洲儿童严重疟疾网络6家医院中的1家医院的26，296名恶性疟原虫住院儿童进行了入院时的厚血涂片检查，以评估含色素粒细胞、单核细胞和寄生虫的预后价值。尽管在所有研究地点中，除一个外，每200个白色血细胞中有>5个色素粒细胞的受试者的死亡风险高于无色素粒细胞的受试者，但通过logistic回归估计的校正比值比（包括其他已确定的严重疟疾标志物）表明，在大多数地点，色素细胞与死亡率之间的相关性为中度至不存在。通过logistic回归模型的受试者工作特征曲线下面积的变化，色素细胞的预测能力较低。尽管在一些研究中心，高水平的色素细胞与致死性结局相关，但它们不是整个非洲结局的有用预测因子。
Background. Plasmodium falciparum malaria is a common cause of morbidity in African children, but identifying those who are likely to die is problematic. Previous studies suggested that circulating malarial pigment might be a useful predictor of severity, but none were large enough to detect any association with mortality.Methods. We used thick blood smears performed on admission for 26,296 children hospitalized with P. falciparum at 1 of 6 hospitals in the Severe Malaria in African Children network to assess the prognostic value of pigment-containing granulocytes, monocytes, and parasites.Results. Although at all but one of the study sites the risk of mortality for subjects presenting with >5 pigmented granulocytes per 200 white blood cells was higher than in subjects with no pigmented granulocytes, adjusted odds ratios estimated through logistic regression, which included other established markers of severe malaria, suggested that associations between pigmented cells and mortality were moderate to nonexistent in most sites. The predictive ability of pigmented cells was low, as measured by the change in the area under the receiver operating characteristic curve of logistic regression models.Conclusions. Although high levels of pigmented cells were associated with a fatal outcome in some study sites, they were not useful predictors of outcome across Africa.