PREDICTORS OF A FATAL OUTCOME FOLLOWING CHILDHOOD CEREBRAL MALARIA

Despite prompt treatment with an effective anti-malarial drug, cerebra l malaria still has a mortality of 20-30%. To identify factors that ma y contribute to this high fatality rate, we have studied the relations hip between clinical and laboratory features and a fatal outcome in 62 4 Gambian children with strictly defined cerebral malaria. One hundred twenty-four children (21.5%) died. Three-quarters of the deaths occur red within 24 hr of admission. Multiple logistic regression analysis s howed that a cold periphery (odds ratio [OR] = 2.7), a deep coma (OR = 2.0), and hypoglycemia (OR = 4.1) were the clinical signs and laborat ory parameters that predicted death most strongly. More than 90% of th e children who died had at least one of these conditions. Also, childr en with elevated urea levels on admission or those who experienced mul tiple episodes of hypoglycemia or multiple convulsions subsequently we re more likely to die. A combination of clinical and laboratory abnorm alities can identify a group of children with cerebral malaria who are most at risk of dying, who require intensive care and who are candida tes for new forms of therapy.