Severity Assessment with Risk Prediction Using Malaria Severity Score in Patients of Falciparum Malaria

According to the World Malaria Report 2010, there were 225 million cases of malaria and an estimated 781 000 deaths in 2009. Even if the diagnostic features of severe malaria have been set out by W.H.O, there are no objective criteria to quantify the severity of each complication. The aim of the study is to find out the usefulness of malaria severity score to predict to assess severity with risk prediction and design appropriate management measures. All adult patients (>18 years) of malaria presented to Department of Medicine of Sri R.L.JALAPPA Hospital and Research centre, for a period of one year. All Proven cases of P. falciparum malaria in adults. (Thin and Thick Smear study/ Rapid Card Test for malaria /QBC test) was included. Study was done in following steps 1. Enrolment of patients as per above criteria. 2. Defining Organ dysfunction as per Malaria severity score. 3. Defining 3 levels of severity of organ dysfunction as per Malaria Severity score. 4. Calculation of Severity score and statistical analysis. GCS was impaired in 6.7%, 36.7 % had impaired serum creatinine and 50 % impaired blood urea. Total bilirubin was high in 27.7 %. Systolic blood pressure less than 90 mmHg was seen in 13.3 %, blood glucose was impaired in 3.3%. Haemoglobin was decreased in 46.7%, low platelets was seen in 36.7% and altered total counts in 26.6 %. In Total Organs involved, 6.66 % patient had five organ system involved that’s highest in our study. Highest group was two organ involvements, i.e. 26.66 %. In the study it was observed that the majority 36.7% had a probability of death 3.1%. The maximum probability of death was 88.8% in 6.7% subjects. Though there were >40% probability of death among 10% of subjects all the patients survived by aggressive management in Medical Intensive Care unit with continuous monitoring, Artesunate based combination therapy and supportive care. Patient was observed and monitored 24 hours in Medical Intensive Unit and treated. Malaria severity score helps to assess severity and risk stratification and to allot better resources. Malaria severity score can help physicians to assess severity and stratify the risk and allocated resources as per need in limited resource setting, a common scenario in our country. It`s helpful in predicting outcome as probability of death is given for each score and patient with high probability of mortality can identified , to provide more attention and quality care. Though further validation and trials , are needed with larger sample size.