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Table 1 Indicators of severe malaria and poor prognosis

From: Clinical review: Severe malaria

Initial World Health Organization criteria from 1990 [11]
Manifestation Features
Cerebral malaria Unrousable coma not attributable to any other cause, with a Glasgow Coma Scale score ≤ 9. Coma should persist for at least 30 min after a generalized convulsion
Severe anemia Hematocrit <15% or hemoglobin < 50 g/l in the presence of parasite count >10 000/μl
Renal failure Urine output <400 ml/24 hours in adults (<12 ml/kg/24 hours in children) and a serum creatinine>265 μmol/l (> 3.0 mg/dl) despite adequate volume repletion
Pulmonary edema and acute respiratory distress syndrome The acute lung injury score is calculated on the basis of radiographic densities, severity of hypoxemia, and positive end-expiratory pressure [26]
Hypoglycemia Whole blood glucose concentration <2.2 mmol/l (<40 mg/dl)
Circulatory collapse (algid malaria) Systolic blood pressure <70 mmHg in patients > 5 years of age (< 50 mmHg in children aged 1–5 years), with cold clammy skin or a core-skin temperature difference >10°C
Abnormal bleeding and/or disseminated intravascular coagulation Spontaneous bleeding from gums, nose, gastrointestinal tract, or laboratory evidence of disseminated intravascular coagulation
Repeated generalized convulsions ≥ 3 convulsions observed within 24 hours
Acidemia/acidosis Arterial pH <7.25 or acidosis (plasma bicarbonate <15 mmol/l)
Macroscopic hemoglobinuria Hemolysis not secondary to glucose-6-phosphate dehydrogenase deficiency
Added World Health Organization criteria from 2000 [12]
Impaired consciousness Rousable mental condition
Prostration or weakness  
Hyperparasitemia > 5% parasitized erythrocytes or > 250 000 parasites/μl (in nonimmune individuals)
Hyperpyrexia Core body temperature >40°C
Hyperbilirubinemia Total bilirubin >43 μmol/l (> 2.5 mg/dl)