The relationship between age and the manifestations of and mortality associated with severe malaria

Arjen Dondorp, Sue J Lee, Md Abul Faiz, Saroj Mishra, Ric Price, Emiliana Tjitra, M Than, Ye Htut, Sanjib Mohanty, Emran Bin Yunus, Ridwanur Rahman, François Nosten, Nicholas Anstey, N Day, Nicholas J White

    Research output: Contribution to journalArticleResearchpeer-review

    Abstract

    Background. The reported case-fatality rate associated with severe malaria varies widely. Whether age is an independent risk factor is uncertain. Methods. In a large, multicenter treatment trial conducted in Asia, the presenting manifestations and outcome of severe malaria were analyzed in relation to age. Results. Among 1050 patients with severe malaria, the mortality increased stepwise, from 6.1% in children (age, <10 years) to 36.5% in patients aged >50 years (P < .001). Compared with adults aged 21-50 years, the decreased risk of death among children (adjusted odds ratio, 0.06; 95% confidence interval, 0.01-0.23; P < .001) and the increased risk of death among patients aged >50 years (adjusted odds ratio, 1.88; 95% confidence interval, 1.01-3.52; P = .046) was independent of the variation in presenting manifestations. The incidence of anemia and convulsions decreased with age, whereas the incidence of hyperparasitemia, jaundice, and renal insufficiency increased with age. Coma and metabolic acidosis did not vary with age and were the strongest predictors of a fatal outcome. The number of severity signs at hospital admission also had a strong prognostic value. Conclusion. Presenting syndromes in severe malaria depend on age, although the incidence and the strong prognostic significance of coma and acidosis are similar at all ages. Age is an independent risk factor for a fatal outcome of the disease. � 2008 by the Infectious Diseases Society of America. All rights reserved.
    Original languageEnglish
    Pages (from-to)151-157
    Number of pages7
    JournalClinical Infectious Diseases
    Volume47
    Issue number2
    Publication statusPublished - 2008

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    Malaria
    Fatal Outcome
    Mortality
    Coma
    Acidosis
    Incidence
    Jaundice
    Multicenter Studies
    Renal Insufficiency
    Anemia
    Seizures
    Odds Ratio
    Confidence Intervals
    Therapeutics

    Cite this

    Dondorp, A., Lee, S. J., Faiz, M. A., Mishra, S., Price, R., Tjitra, E., ... White, N. J. (2008). The relationship between age and the manifestations of and mortality associated with severe malaria. Clinical Infectious Diseases, 47(2), 151-157.
    Dondorp, Arjen ; Lee, Sue J ; Faiz, Md Abul ; Mishra, Saroj ; Price, Ric ; Tjitra, Emiliana ; Than, M ; Htut, Ye ; Mohanty, Sanjib ; Yunus, Emran Bin ; Rahman, Ridwanur ; Nosten, François ; Anstey, Nicholas ; Day, N ; White, Nicholas J. / The relationship between age and the manifestations of and mortality associated with severe malaria. In: Clinical Infectious Diseases. 2008 ; Vol. 47, No. 2. pp. 151-157.
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    abstract = "Background. The reported case-fatality rate associated with severe malaria varies widely. Whether age is an independent risk factor is uncertain. Methods. In a large, multicenter treatment trial conducted in Asia, the presenting manifestations and outcome of severe malaria were analyzed in relation to age. Results. Among 1050 patients with severe malaria, the mortality increased stepwise, from 6.1{\%} in children (age, <10 years) to 36.5{\%} in patients aged >50 years (P < .001). Compared with adults aged 21-50 years, the decreased risk of death among children (adjusted odds ratio, 0.06; 95{\%} confidence interval, 0.01-0.23; P < .001) and the increased risk of death among patients aged >50 years (adjusted odds ratio, 1.88; 95{\%} confidence interval, 1.01-3.52; P = .046) was independent of the variation in presenting manifestations. The incidence of anemia and convulsions decreased with age, whereas the incidence of hyperparasitemia, jaundice, and renal insufficiency increased with age. Coma and metabolic acidosis did not vary with age and were the strongest predictors of a fatal outcome. The number of severity signs at hospital admission also had a strong prognostic value. Conclusion. Presenting syndromes in severe malaria depend on age, although the incidence and the strong prognostic significance of coma and acidosis are similar at all ages. Age is an independent risk factor for a fatal outcome of the disease. � 2008 by the Infectious Diseases Society of America. All rights reserved.",
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    author = "Arjen Dondorp and Lee, {Sue J} and Faiz, {Md Abul} and Saroj Mishra and Ric Price and Emiliana Tjitra and M Than and Ye Htut and Sanjib Mohanty and Yunus, {Emran Bin} and Ridwanur Rahman and Fran{\~A}§ois Nosten and Nicholas Anstey and N Day and White, {Nicholas J}",
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    Dondorp, A, Lee, SJ, Faiz, MA, Mishra, S, Price, R, Tjitra, E, Than, M, Htut, Y, Mohanty, S, Yunus, EB, Rahman, R, Nosten, F, Anstey, N, Day, N & White, NJ 2008, 'The relationship between age and the manifestations of and mortality associated with severe malaria', Clinical Infectious Diseases, vol. 47, no. 2, pp. 151-157.

    The relationship between age and the manifestations of and mortality associated with severe malaria. / Dondorp, Arjen; Lee, Sue J; Faiz, Md Abul; Mishra, Saroj; Price, Ric; Tjitra, Emiliana; Than, M; Htut, Ye; Mohanty, Sanjib; Yunus, Emran Bin; Rahman, Ridwanur; Nosten, François; Anstey, Nicholas; Day, N; White, Nicholas J.

    In: Clinical Infectious Diseases, Vol. 47, No. 2, 2008, p. 151-157.

    Research output: Contribution to journalArticleResearchpeer-review

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    AU - Dondorp, Arjen

    AU - Lee, Sue J

    AU - Faiz, Md Abul

    AU - Mishra, Saroj

    AU - Price, Ric

    AU - Tjitra, Emiliana

    AU - Than, M

    AU - Htut, Ye

    AU - Mohanty, Sanjib

    AU - Yunus, Emran Bin

    AU - Rahman, Ridwanur

    AU - Nosten, François

    AU - Anstey, Nicholas

    AU - Day, N

    AU - White, Nicholas J

    PY - 2008

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    N2 - Background. The reported case-fatality rate associated with severe malaria varies widely. Whether age is an independent risk factor is uncertain. Methods. In a large, multicenter treatment trial conducted in Asia, the presenting manifestations and outcome of severe malaria were analyzed in relation to age. Results. Among 1050 patients with severe malaria, the mortality increased stepwise, from 6.1% in children (age, <10 years) to 36.5% in patients aged >50 years (P < .001). Compared with adults aged 21-50 years, the decreased risk of death among children (adjusted odds ratio, 0.06; 95% confidence interval, 0.01-0.23; P < .001) and the increased risk of death among patients aged >50 years (adjusted odds ratio, 1.88; 95% confidence interval, 1.01-3.52; P = .046) was independent of the variation in presenting manifestations. The incidence of anemia and convulsions decreased with age, whereas the incidence of hyperparasitemia, jaundice, and renal insufficiency increased with age. Coma and metabolic acidosis did not vary with age and were the strongest predictors of a fatal outcome. The number of severity signs at hospital admission also had a strong prognostic value. Conclusion. Presenting syndromes in severe malaria depend on age, although the incidence and the strong prognostic significance of coma and acidosis are similar at all ages. Age is an independent risk factor for a fatal outcome of the disease. � 2008 by the Infectious Diseases Society of America. All rights reserved.

    AB - Background. The reported case-fatality rate associated with severe malaria varies widely. Whether age is an independent risk factor is uncertain. Methods. In a large, multicenter treatment trial conducted in Asia, the presenting manifestations and outcome of severe malaria were analyzed in relation to age. Results. Among 1050 patients with severe malaria, the mortality increased stepwise, from 6.1% in children (age, <10 years) to 36.5% in patients aged >50 years (P < .001). Compared with adults aged 21-50 years, the decreased risk of death among children (adjusted odds ratio, 0.06; 95% confidence interval, 0.01-0.23; P < .001) and the increased risk of death among patients aged >50 years (adjusted odds ratio, 1.88; 95% confidence interval, 1.01-3.52; P = .046) was independent of the variation in presenting manifestations. The incidence of anemia and convulsions decreased with age, whereas the incidence of hyperparasitemia, jaundice, and renal insufficiency increased with age. Coma and metabolic acidosis did not vary with age and were the strongest predictors of a fatal outcome. The number of severity signs at hospital admission also had a strong prognostic value. Conclusion. Presenting syndromes in severe malaria depend on age, although the incidence and the strong prognostic significance of coma and acidosis are similar at all ages. Age is an independent risk factor for a fatal outcome of the disease. � 2008 by the Infectious Diseases Society of America. All rights reserved.

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