Clinical and laboratory predictors of death in African children with features of severe malaria: a systematic review and meta-analysis

The criteria for defining severe malaria have evolved over the last 20 years. We aimed to assess the strength of association of death with features currently characterizing severe malaria through a systematic review and meta-analysis. Electronic databases (Medline, Embase, Cochrane Database of Syste...

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Bibliographic Details
Published in:BMC medicine 2017-08, Vol.15 (1), p.147-17, Article 147
Main Authors: Sypniewska, Paulina, Duda, Jose F, Locatelli, Isabella, Althaus, Clotilde Rambaud, Althaus, Fabrice, Genton, Blaise
Format: Article
Language:English
Subjects:
Africa
Anemia
Breathing
Child
Children
Children & youth
Coma
Consciousness
Criteria
Death
Diagnostic systems
Documents
Epidemiology
Evidence-based medicine
Fatalities
Health aspects
Humans
Hypoglycemia
Kidneys
Laboratories
Literature reviews
Malaria
Malaria - mortality
Malaria - physiopathology
Medical prognosis
Meta-analysis
Mortality
Predictors
Prognosis
Quality assessment
Quality control
Renal failure
Reviews
Risk factors
Severe malaria
Systematic review
Vector-borne diseases
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Summary:The criteria for defining severe malaria have evolved over the last 20 years. We aimed to assess the strength of association of death with features currently characterizing severe malaria through a systematic review and meta-analysis. Electronic databases (Medline, Embase, Cochrane Database of Systematic Reviews, Thomson Reuters Web of Knowledge) were searched to identify publications including African children with severe malaria. PRISMA guidelines were followed. Selection was based on design (epidemiological, clinical and treatment studies), setting (Africa), participants (children  2. Features with the lowest pooled ORs were impaired consciousness (0.58, 95% CI 0.25-1.37), severe anemia (0.76, 95% CI 0.5- 1.13), and prostration (1.12, 95% CI 0.45-2.82). The findings of this meta-analysis show that the strength of association between the criteria defining severe malaria and death is quite variable for each clinical and/or laboratory feature (OR ranging from 0.58 to 5.96). This ranking allowed the identification of features weakly associated with death, such as impaired consciousness and prostration, which could assist to improve case definition, and thus optimize antimalarial treatment.
ISSN:1741-7015
1741-7015
DOI:10.1186/s12916-017-0906-5