Sequential Organ Failure Assessment score as an outcome predictor in malarial multiorgan dysfunction syndrome

Introduction

Acute severe malaria is one of the leading causes of multiorgan dysfunction syndrome (MODS) in a developing country like India, and is associated with significant mortality. The outcome of malarial MODS predicted in various studies is extremely variable and dependent on many patient parameters.

Objective

We prospectively evaluated the correlation of the APACHE II score, parasite index, procalcitonin (PCT) levels, number of organ dysfunctions/failures and Sequential Organ Failure Assessment (SOFA) score with the outcome of severe malaria.

Methods

Eleven patients with acute severe malaria with MODS were treated in our ICU in the last 5 months. All these patients were treated with artesunate and/or quinine as per the WHO antimalarial treatment schedule, along with standard ICU care. The APACHE II and SOFA scores were calculated on admission. PCT levels were measured semiquantitatively on admission. The parasite index was confirmed by two pathologists.

Results

Nine out of 11 patients survived without any residual organ damage, and the remaining two died due to MODS (Figure 1). Both these patients had five organ dysfunctions on admission, and their SOFA scores were 18 and 20, respectively. They had a low parasitic index of 1% and 2.5% and their PCT levels were 0.5–2 and >10 (semiquantitative method), respectively. Their APACHE II scores were 16 and 10.

Figure 1

Conclusion

The pretreatment APACHE II score, parasite index, PCT levels and number of organs involved have variable correlation with mortality and are not consistent predictors of outcome. A higher SOFA score on admission is a more reliable predictor of mortality in malarial MODS.