Journal Mobile

KH Koh, Cl Tan, PH Chew
Journal Issue: 
Volume 36: Issue 2: 2006





Identify  the  risk  factors  and  the  clinical  impact  of  ARF  in patients with severe falciparum malaria.


Intensive care unit cases of severe falciparum malaria of Sarawak General Hospital were analysed.


Out of 40 cases of severe falciparum malaria, 19 developed ARF.  Patients with ARF  were  older  (p=0·030), had  higher  AST  (p=0·014), higher  unconjugated  bilirubin (p=0·041),  and  lower  globulin  (p=0·015).   Aspartate  transaminase  level  positively correlated with creatinine and urea level (log AST and urea: r=0·464, p=0·004; log AST and  log  creatinine: r=0·430, p=0·008); while  unconjugated  bilirubin  level  positively correlated  with  creatinine  level  with  geometric  transformation  (r=0·402, p=0·020). Patients with ARF have higher mortality (p=0·004), and more failing organs (p = 0·0003). Patients with ARF that died had a higher number of organs failing compared with those that  survived  (p=0·043).  Among  patients  with  total  parasite  count  of  >300,000/μL, those patients treated with dialysis, haemofiltration or exchange transfusion developed less organ failure (p=0·050).  Logistic regression with adjustment for age and malarial complications identified ARF to be the major predictor of mortality.


1) Patients with severe falciparum malaria who developed ARF have higher  rate  of  haemolysis, more  organs  failing  and  higher  mortality  rate.   2) Dialysis, haemofiltration or exchange transfusion may reduced the rate of organ failure among patients with parasite count >300000/μL.