Newton et al reported the Malaria Prognostic Index (MPI) for evaluating patients with several falciparum malaria. This can help to identify a patient who may benefit from more aggressive management. The authors are from Thailand, Laos, Australia and England.
Parameters:
(1) Glasgow coma score (GCS)
(2) parasitemia in absolute count per µL
(3) plasma lactate in mmol/L (normal < 4.0 mmol/L)
(4) serum total bilirubin in µmol/L (normal 5.1 to 17 µmol/L)
(5) percent pigmented parasites
(6) treatment with artemisinin-based combination therapy (ACT)
|
Parameter |
Finding |
Points |
|
Glasgow Coma Score |
12 to 15 |
0 |
|
|
5 to 11 |
1.5 |
|
|
3 or 4 |
4.5 |
|
parasitemia |
<= 315,000 per µL |
0 |
|
|
> 315,000 per µL |
1 |
|
plasma lactate |
<= 5 mmol/L |
0 |
|
|
> 5 mmol/L |
2.5 |
|
serum total bilirubin |
<= 58 µmol/L |
0 |
|
|
> 58 µmol/L |
1 |
|
percent pigmented parasites |
<= 20% |
0 |
|
|
> 20% |
1.5 |
|
ACT therapy |
no |
0 |
|
|
yes |
-1.5 |
where:
• The authors reported 2 models. This is the MPI B model.
total score =
= SUM(points for all 6 parameters)
Interpretation:
• minimum score: -1.5
• maximum score: 10.5
• The higher the score the greater the mortality rate.
If the data in Figure 1 is analyzed:
X = (0.94 * (score)) - 5.34
mortality rate =
= 1 / (1 + EXP((-1) * X))
Performance:
• The are under the ROC curve was 0.97
• A cutoff >= 3.5 had a sensitivity of 95% and specificity of 91%.
Specialty: Infectious Diseases
