Capillary refill time as an independent prognostic indicator in severe and complicated malaria
Capillary refill time as an independent prognostic indicator in severe and complicated malaria
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DOI：
10.1016/j.jpeds.2006.07.040
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发表时间：
2006-11-01
影响因子：
5.1
通讯作者：
Horstmann, Rolf D.
中科院分区：
文献类型：
--
作者：
Evans, Jennifer A.;May, Juergen;Horstmann, Rolf D.
目标。改进识别疟疾流行地区有死于疟疾危险的儿童的算法。研究设计。在一项前瞻性研究中，对西非加纳一家三级转诊中心收治的2446名患有严重和复杂疟疾的儿童进行了12项临床和实验室体征评估，作为死亡指标。延长的毛细血管再充血时间（pCRT）与酸中毒、昏迷和呼吸窘迫一起被确定为死亡的独立预后指标。在临床症状中，pCRT除了使患者出现昏迷和呼吸窘迫外，还使其死亡风险从4倍增加到11倍。由于承认pCRT是一项独立的死亡指标，因此有理由将其列入严重液体复杂疟疾的界定标准，并改善了疟疾患者分诊时临床检查的使用。由于pCRT已被证明可以反映儿童的循环障碍，因此应将其纳入未来的研究中，作为表明是否需要静脉输液的可能迹象。
Objectives. To improve algorithms for the identification of children at risk of dying of malaria in endemic areas.Study design. In a prospective study of 2446 children with severe and complicated malaria admitted to a tertiary referral center in Ghana, West Africa, 12 clinical and laboratory signs were evaluated as indicators of death.Results. A prolonged (> 2 seconds) capillary refill time (pCRT) was identified as an independent prognostic indicator of death along with acidosis, coma, and respiratory distress. Among the clinical signs, pCRT increased the risk of dying from 4-fold to 11-fold when present in addition to coma and respiratory distress.Conclusions. The recognition of pCRT as an independent indicator of death justifies its inclusion as a defining criterion of severe quid complicated malaria and improves the use of clinical examinations in the triage of patients with malaria. As pCRT has been shown to reflect circulatory disturbances in children, it should be included in upcoming studies as a possible sign to indicate the need for intravenous fluid administration.