Utility of qSOFA and modified SOFA in severe malaria presenting as sepsis

Autoři: Prapit Teparrukkul aff001;  Viriya Hantrakun aff002;  Mallika Imwong aff002;  Nittaya Teerawattanasook aff004;  Gumphol Wongsuvan aff002;  Nicholas PJ. Day aff002;  Arjen M. Dondorp aff002;  T. Eoin West aff006;  Direk Limmathurotsakul aff002
Působiště autorů: Medical Department, Sunpasitthiprasong Hospital, Ubon Ratchthani, Thailand aff001;  Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand aff002;  Department of Molecular Tropical Medicine and Genetics, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand aff003;  Medical Technology Department, Sunpasitthiprasong Hospital, Ubon Ratchthani, Thailand aff004;  Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom aff005;  Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Washington, Seattle, Washington, United States of America aff006;  Department of Global Health, University of Washington, Seattle, Washington, United states of America aff007;  Department of Tropical Hygiene, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand aff008
Vyšlo v časopise: PLoS ONE 14(10)
Kategorie: Research Article
doi: https://doi.org/10.1371/journal.pone.0223457


Sepsis can be caused by malaria infection, but little is known about the utility of the quick Sequential (Sepsis-Related) Organ Failure Assessment (qSOFA) and SOFA score in malaria. We conducted a prospective observational study from March 2013 to February 2017 to examine adults admitted with community-acquired infection in a tertiary-care hospital in Ubon Ratchathani, Northeast Thailand (Ubon-sepsis). Subjects were classified as having sepsis if they had a modified SOFA score ≥2 within 24 hours of admission. Serum was stored and later tested for malaria parasites using a nested PCR assay. Presence of severe malaria was defined using modified World Health Organization criteria. Of 4,989 patients enrolled, 153 patients (3%) were PCR positive for either Plasmodium falciparum (74 [48%]), P. vivax (69 [45%]), or both organisms (10 [7%]). Of 153 malaria patients, 80 were severe malaria patients presenting with sepsis, 70 were non-severe malaria patients presenting with sepsis, and three were non-severe malaria patients presenting without sepsis. The modified SOFA score (median 5; IQR 4–6; range 1–18) was strongly correlated with malaria severity determined by the number of World Health Organization severity criteria satisfied by the patient (Spearman’s rho = 0.61, p<0.001). Of 80 severe malaria patients, 2 (2.5%), 11 (14%), 62 (77.5%) and 5 (6%), presented with qSOFA scores of 0, 1, 2 and 3, respectively. Twenty eight-day mortality was 1.3% (2/153). In conclusion, qSOFA and SOFA can serve as markers of disease severity in adults with malarial sepsis. Patients presenting with a qSOFA score of 1 may also require careful evaluation for sepsis; including diagnosis of cause of infection, initiation of medical intervention, and consideration for referral as appropriate.

Klíčová slova:

Blood – Diagnostic medicine – Malaria – Nosocomial infections – Plasmodium – Respiratory infections – Sepsis – Nested polymerase chain reaction


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2019 Číslo 10
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