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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
immunology and microbiology
Blood glucose and prognosis in children with presumed severe malaria: Is there a threshold for 'hypoglycaemia'?
Tropical Medicine and International Health, Volume 15, No. 2, Year 2010
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Description
Objectives Hypoglycaemia (glucose <2.2 mmol/l) is a defining feature of severe malaria, but the significance of other levels of blood glucose has not previously been studied in children with severe malaria. Methods A prospective study of 437 consecutive children with presumed severe malaria was conducted in Mali. We defined hypoglycaemia as <2.2 mmol/l, low glycaemia as 2.2-4.4 mmol/l and hyperglycaemia as >8.3 mmol/l. Associations between glycaemia and case fatality were analysed for 418 children using logistic regression models and a receiver operator curve (ROC). Results There was a significant difference between blood glucose levels in children who died (median 4.6 mmol/l) and survivors (median 7.6 mmol/l, P < 0.001). Case fatality declined from 61.5% of the hypoglycaemic children to 46.2% of those with low glycaemia, 13.4% of those with normal glycaemia and 7.6% of those with hyperglycaemia (P < 0.001). Logistic regression showed an adjusted odds ratio (AOR) of 0.75 (0.64-0.88) for case fatality per 1 mmol/l increase in baseline blood glucose. Compared to a normal blood glucose, hypoglycaemia and low glycaemia both significantly increased the odds of death (AOR 11.87, 2.10-67.00; and 5.21, 1.86-14.63, respectively), whereas hyperglycaemia reduced the odds of death (AOR 0.34, 0.13-0.91). The ROC [area under the curve at 0.753 (95% CI 0.684-0.820)] indicated that glycaemia had a moderate predictive value for death and identified an optimal threshold at glycaemia <6.1 mmol/l, (sensitivity 64.5% and specificity 75.1%). Conclusions If there is a threshold of blood glucose which defines a worse prognosis, it is at a higher level than the current definition of 2.2 mmol/l. © 2009 Blackwell Publishing Ltd.
Authors & Co-Authors
Willcox, Merlin L.
United Kingdom, Oxford
University of Oxford
Switzerland, Geneve
Antenna Technologies
Forster, Mathieu
Canada, Quebec
Université Laval
Switzerland, Bern
University of Bern
Dicko, Moussa I.
Mali, Bamako
University of Bamako Faculty of Medicine, Pharmacy and Odonto-stomatology
Graz, Bertrand
Switzerland, Geneve
Antenna Technologies
Switzerland, Lausanne
Université de Lausanne Unil
Mayon-White, Richard T.
United Kingdom, Oxford
University of Oxford
Barennes, Hubert
Democratic Republic Congo, Vientiane
Institut Francophone Pour la Médecine Tropicale
Statistics
Citations: 44
Authors: 6
Affiliations: 7
Identifiers
Doi:
10.1111/j.1365-3156.2009.02444.x
ISSN:
13602276
e-ISSN:
13653156
Research Areas
Infectious Diseases
Maternal And Child Health
Study Design
Cohort Study
Case-Control Study
Study Locations
Mali