Utility of Prognostic Scoring in Severe Malaria

This chapter describe about sequential APACHE II Scores for Prediction of Mortality in Patients with Severe Malaria and Admitted to Critical Care Facilities. The rapid development of intensive care units (ICUs) created the need for quantitative and clinically relevant surrogate outcome measures in order to evaluate the effectiveness of treatment practices. This longitudinal study was carried out after getting necessary ethics committee approval. Score of APACHE II on days 0, 2nd and 7th were evaluated and appropriate statistical tests were applied. Out of 120 patients, 54 patients were of P. vivax, P. falciparum - 60 and six mixed infection patients. Mean APACHE II score was maximum on day 0 followed by day 2 and 7 in decreasing order. Serial scoring may exhibit an upward or downward trend, according to the current study, and is a better prognosis indication than a single severity assessment. The APACHE II score was statistically greater on all days in patients who didn’t survive. The Receiver Operating Characteristic (ROC) curve when plotted showed score of APACHE II on day 2 - cut-off 14 to be the most valid in mortality prediction with a sensitivity of 64.28% and specificity of 87.80% as most of the results were on the left from the diagonal line and had greatest area under the curve. Comparing APACHE II sequential measurement to a single score measurement can be advised. As parasite count is a precise predictor of the severity of malaria, it can be included in the prognostic scoring system. Since the sequential score from the second day significantly distinguishes between survivors and non-survivors, the prognostic score APACHE II was found to be useful in patients with severe falciparum/vivax malaria who required intensive care treatment. The optimum cut-off for identifying individuals at high risk of mortality is 14, and the Day-2 APACHE II score is an ideal biomarker for predicting the outcomes of ICU patient. Malaria is a major cause of tropical sepsis in India leading to significant amount of mortality. As a technique for determining the severity of malaria, the APACHE II trend and inclusion of the parasite count along with the severity score for each of the seven organ dysfunctions may perform better.