Introduction: Critically ill severe malaria constitutes one of the major hospital admissions in Indian setting. Clinical studies identifying the factors associated with acute kidney injury (AKI) in malaria are lacking. This study aimed to identify these factors.
Methods: This prospective observational study was conducted in a tertiary care center of North India. All adult patients with severe malaria were studied during 2012–2014.
Results: The study included 79 patients and AKI was observed in 36 patients. Of these 79 patients, 52.7% were Plasmodium falciparum positive and 47.2% were Plasmodium vivax positive. In AKI patients, thrombocytopenia and jaundice were the most common other complications seen. Among P. vivax malarial patients, 17 (36%) patients had AKI. Features associated with AKI among patients admitted with P. vivax malaria were as follows: tachycardia (adjusted relative risk [RR]: 3.9; 95% confidence interval [CI]: 1.1–13.7), direct hyperbilirubinemia (adjusted RR: 4.7; 95% CI: 1.4–15.2), anemia (adjusted RR: 6; 95% CI: 1.7–22.4), and sepsis (adjusted RR: 3.3; 95% CI: 1.1–13.7). The presence of tachycardia, acidosis, cerebral malaria, acute respiratory distress syndrome/acute lung injury, hypotensive shock, and poor Glasgow Coma Scale were associated with higher mortality in patients with AKI. Patients who required mechanical ventilation and/or vasopressor support had higher mortality.
Conclusion: P. vivax is an important cause of severe malaria with AKI in our setting. Various other clinical features are associated with AKI and related mortality.
Lacerda MV, Mourão MP, Alexandre MA, Siqueira AM, Magalhães BM, Martinez-Espinosa FE, et al. Understanding the clinical spectrum of complicated Plasmodium vivax malaria: A systematic review on the contributions of the Brazilian literature. Malar J 2012;11:12.
Sitprija V. Nephropathy in falciparum malaria. Kidney Int 1988;34:867-77.
Mehta RL, Kellum JA, Shah SV, Molitoris BA, Ronco C, Warnock DG, et al. Acute kidney injury network: Report of an initiative to improve outcomes in acute kidney injury. Crit Care 2007;11:R31.
Mehndiratta S, Rajeshwari K, Dubey AP. Multiple-organ dysfunction in a case of Plasmodium vivax malaria. J Vector Borne Dis 2013;50:71-3.
Rahimi BA, Thakkinstian A, White NJ, Sirivichayakul C, Dondorp AM, Chokejindachai W. Severe vivax malaria: A systematic review and meta-analysis of clinical studies since 1900. Malar J 2014;13:481.
Ratanarat R, Skulratanasak P, Tangkawattanakul N, Hantaweepant C. Clinical accuracy of RIFLE and acute Kidney Injury Network (AKIN) criteria for predicting hospital mortality in critically ill patients with multi-organ dysfunction syndrome. J Med Assoc Thai 2013;96 Suppl 2:S224-31.
Xiong J, Tang X, Hu Z, Nie L, Wang Y, Zhao J, et al. The RIFLE versus AKIN classification for incidence and mortality of acute kidney injury in critical ill patients: A meta-analysis. Sci Rep 2015;5:17917.
Mishra SK, Panigrahi P, Mishra R, Mohanty S. Prediction of outcome in adults with severe falciparum malaria: A new scoring system. Malar J 2007;6:24.
von Seidlein L, Olaosebikan R, Hendriksen IC, Lee SJ, Adedoyin OT, Agbenyega T, et al. Predicting the clinical outcome of severe falciparum malaria in African children: Findings from a large randomized trial. Clin Infect Dis 2012;54:1080-90.
Saravu K, Rishikesh K, Parikh CR. Risk factors and outcomes stratified by severity of acute kidney injury in malaria. PLoS One 2014;9:e90419.
Kute VB, Trivedi HL, Vanikar AV, Shah PR, Gumber MR, Patel HV, et al. Plasmodium vivax malaria-associated acute kidney injury, India, 2010-2011. Emerg Infect Dis 2012;18:842-5.
Hanson J, Lee SJ, Mohanty S, Faiz MA, Anstey NM, Charunwatthana P, et al. Asimple score to predict the outcome of severe malaria in adults. Clin Infect Dis 2010;50:679-85.
Dondorp AM, Lee SJ, Faiz MA, Mishra S, Price R, Tjitra E, et al. The relationship between age and the manifestations of and mortality associated with severe malaria. Clin Infect Dis 2008;47:151-7.
Tangpukdee N, Duangdee C, Wilairatana P, Krudsood S. Malaria diagnosis: A brief review. Korean J Parasitol 2009;47:93-102.