Childhood cerebral malaria: Pattern of biochemical parameters and clinical outcome in a Nigerian tertiary hospital

IF 2.3 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Clinical Epidemiology and Global Health Pub Date : 2024-10-08 DOI:10.1016/j.cegh.2024.101786

Ayobami Oyetunji Alabi , Olanike Taye Oladibu , Samson Aderemi Ojedokun , Abraham Ifeoluwa Akinbola , Taiwo Wulemot Oloyede , Bukola Adetutu Sayomi

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Abstract

Background

The outcome of children with cerebral malaria involves an interplay of factors including clinical and biochemical parameters, a deep knowledge of these laboratory biochemical parameters is essential. Thus, this study aimed to assess the pattern of the biochemical parameters in children with cerebral malaria and how it may affect the clinical outcomes.

Methods

A prospective observational cohort study among fifty subjects at the children's emergency unit. The participants were children aged 6 months to 12 years admitted with a history of fever and altered sensorium, demonstrable malaria parasite in the blood film and cerebrospinal fluid (CSF) analysis not suggestive of central nervous system (CNS) infections. Detailed history was taken with thorough examinations of each child. Samples were collected for malaria parasites, serum electrolytes, urea, creatinine, and blood glucose values. The clinical outcomes were correlated with the analyte levels.

Results

60 % of the children survived without any sequelae with the highest proportion (70 %) of survivors being children above five years. Children with hypoglycemia had a 3.5-fold higher risk of poor outcomes and this is statistically significant (RR = 3.65 p = 0.014). Hyperkalaemia was significantly associated with poor outcomes (RR = 2.57, p = 0.009). Subjects with hypochloraemia had three times the risk of poor outcome and mortality with statistically significant association (RR = 3.07, χ² = 8.519, p = 0.004). There was a significant association between metabolic acidosis and poor clinical outcome. (RR = 1.99, χ² = 4.089, p = 0.043). The parasite density was significantly associated with the serum bicarbonate (HCO₃⁻) and Chloride, p-value < 0.05.

Conclusion

Hypoglycaemia, hyperkalemia, hypochloremia and metabolic acidosis were significantly associated with poor outcomes, thus, good predictors of clinical outcomes in children diagnosed with cerebral malaria. Periodic evaluation and monitoring of these parameters is essential for prompt intervention to forestall devastating outcomes.

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儿童脑型疟疾：尼日利亚一家三级医院的生化指标模式和临床结果

背景脑疟疾患儿的预后涉及临床和生化指标等多种因素的相互作用，因此深入了解这些实验室生化指标至关重要。因此，本研究旨在评估脑型疟疾患儿的生化指标模式及其对临床结果的影响。研究对象为 6 个月至 12 岁的儿童，入院时有发热和感觉改变的病史，血片中有明显的疟原虫，脑脊液（CSF）分析未提示中枢神经系统（CNS）感染。详细询问病史并对每个儿童进行全面检查。采集样本检测疟原虫、血清电解质、尿素、肌酐和血糖值。结果60%的儿童存活下来，没有留下任何后遗症，其中五岁以上儿童的存活率最高（70%）。患低血糖症的儿童出现不良后果的风险比正常儿童高 3.5 倍，这在统计学上有显著意义（RR = 3.65 p = 0.014）。高钾血症与不良预后显著相关（RR = 2.57，p = 0.009）。低氯血症受试者的不良预后和死亡风险是正常人的三倍，且有统计学意义（RR = 3.07，χ2 = 8.519，P = 0.004）。代谢性酸中毒与不良临床预后之间存在明显关联。(RR = 1.99，χ2 = 4.089，p = 0.043）。结论高血糖、高钾血症、低氯血症和代谢性酸中毒与不良预后显著相关，因此是诊断为脑疟疾的儿童临床预后的良好预测因素。定期评估和监测这些参数对于及时干预以避免破坏性后果至关重要。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical Epidemiology and Global Health PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH-

CiteScore

4.60

自引率

7.70%

发文量

218

审稿时长

66 days

期刊介绍： Clinical Epidemiology and Global Health (CEGH) is a multidisciplinary journal and it is published four times (March, June, September, December) a year. The mandate of CEGH is to promote articles on clinical epidemiology with focus on developing countries in the context of global health. We also accept articles from other countries. It publishes original research work across all disciplines of medicine and allied sciences, related to clinical epidemiology and global health. The journal publishes Original articles, Review articles, Evidence Summaries, Letters to the Editor. All articles published in CEGH are peer-reviewed and published online for immediate access and citation.