Risk Factors for Severe Disease in Adults with Falciparum Malaria
Risk Factors for Severe Disease in Adults with Falciparum Malaria
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DOI：
10.1086/597258
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发表时间：
2009-04-01
影响因子：
11.8
通讯作者：
Pasvol, Geoffrey
中科院分区：
文献类型：
--
作者：
Phillips, Anastasia;Bassett, Paul;Pasvol, Geoffrey
背景在16年的时间里，我们进行了一项临床研究，在全球范围内获得疟疾的成年人从疟疾非流行国家，以确定严重的恶性疟原虫疟疾的危险因素。对1991年至2006年我单位收治的所有确诊疟疾患者进行前瞻性评价。根据（1）严格的世界卫生组织（WHO）标准、（2）不良结局的综合指标和（3）住院时间，通过Logistic和线性回归分析确定预测疾病严重程度的因素。我们评估了676例疟疾，482例（71%）由恶性疟原虫引起，194例（29%）由非恶性疟原虫引起。黑人患者发生WHO定义的重度恶性疟疾的风险显著降低，亚洲患者发生重度恶性疟疾的几率高8.05倍（95%置信区间[CI]，2.93-22.1倍），白色患者发生重度恶性疟疾的几率高8.20倍（95% CI，2.94-22.9倍）。与白色或亚洲患者相比，黑人患者不良结局和住院时间延长的风险也降低。在6名死于恶性疟疾的病人中，没有一个是黑人。在单变量分析中，寄生虫血症>= 2%的患者患严重恶性疟疾的几率是寄生虫血症患者的12倍
Background. Over a 16-year period, we conducted a clinical study of malaria acquired worldwide in adults from malaria-nonendemic countries, to determine risk factors for severe Plasmodium falciparum malaria.Methods. All patients with confirmed malaria who were managed by our unit from 1991 to 2006 were prospectively evaluated. Factors predicting disease severity according to (1) strict World Health Organization (WHO) criteria, (2) a composite measure of unfavorable outcome, and (3) length of hospital stay were identified by logistic and linear regression analyses.Results. We evaluated 676 episodes of malaria, 482 (71%) due to P. falciparum and 194 (29%) due to non-falciparum parasites. Black patients had a significantly reduced risk of developing WHO-defined severe falciparum malaria, with Asian patients having odds of severe falciparum malaria that were 8.05-fold (95% confidence interval [CI], 2.93-22.1-fold) higher and white patients having odds that were 8.20-fold (95% CI, 2.94-22.9-fold) higher. Black patients also had a reduced risk of an unfavorable outcome and of a prolonged stay in the hospital, compared with the risks for white or Asian patients. Of 6 patients with falciparum malaria who died, none were black. In univariate analysis, patients with parasitemias of >= 2% had odds of severe falciparum malaria 12-fold higher than those of patients with parasitemias of