Clinical Factors for Severity of Plasmodium falciparum Malaria in Hospitalized Adults in Thailand

Plasmodium falciparum is a major cause of severe malaria in Southeast Asia, however, there is limited information regarding clinical factors associated with the severity of falciparum malaria from this region. We performed a retrospective case-control study to compare clinical factors and outcomes between patients with severe and non-severe malaria, and to identify clinical factors associated with the requirement for intensive care unit (ICU) admission of patients with severe falciparum malaria among hospitalized adults in Southeast Asia. A total of 255 patients with falciparum malaria in the Hospital for Tropical Diseases in Bangkok, Thailand between 2006 and 2012 were included. We identified 104 patients with severe malaria (cases) and 151 patients with non-severe malaria (controls). Patients with falciparum malaria with following clinical and laboratory characteristics on admission (1) referrals, (2) no prior history of malaria, (3) body temperature of.38.5uC, (4) white blood cell counts.106109/mL, (5) presence of schizonts in peripheral blood smears, and (6) albumin concentrations of,3.5 g/dL, were more likely to develop severe malaria (P,0.05). Among patients with severe malaria, patients who met $3 of the 2010 WHO criteria had sensitivity of 79.2 % and specificity of 81.8 % for requiring ICU admission. Multivariate analysis identified the following as independent associated factors for severe malaria requiring ICU admission