{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,4]],"date-time":"2026-04-04T20:48:22Z","timestamp":1775335702606,"version":"3.50.1"},"reference-count":53,"publisher":"American Society of Tropical Medicine and Hygiene","issue":"6","license":[{"start":{"date-parts":[[2024,12,4]],"date-time":"2024-12-04T00:00:00Z","timestamp":1733270400000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,12,4]]},"abstract":"<jats:title>ABSTRACT.<\/jats:title>\n<jats:p>More than 1,000 children under 5 years of age die every day from malaria. Cerebral malaria (CM) is the most severe and deadly manifestation of the disease. The occurrence of multiple organ dysfunction syndrome (MODS) has been associated with increased mortality in adult patients with CM. However, little is known about the frequency and severity of MODS in children with CM. This was a retrospective study of 199 pediatric patients with CM admitted to a referral hospital in Blantyre, Malawi, between January 2019 and May 2023. Data were abstracted from charts to calculate scores using four established scoring systems: Pediatric Logistic Organ Dysfunction-2 (PELOD-2), Pediatric Sequential Organ Failure Assessment (pSOFA), Signs of Inflammation in Children that Can Kill (SICK), and Lambar\u00e9n\u00e9 Organ Dysfunction Score (LODS). Mortality was 16% (<jats:italic>n<\/jats:italic> = 32). All four scoring systems were predictive of mortality, but the PELOD-2 and pSOFA scores outperformed the others with area under the curve values of 0.75 and 0.67, respectively. Multiple organ dysfunction syndrome was diagnosed in 182 patients (91%) using the PELOD-2 score, 172 patients (86%) using the pSOFA score, 99 patients (50%) using the SICK score, and 30 patients (15%) using the LODS. The PELOD-2 and pSOFA identify MODS in children with CM but require laboratory-based testing that is often unavailable in malaria-endemic areas. Furthermore, these scoring systems may identify primary malarial disease pathology rather than true organ dysfunction. Simplified scoring systems designed to recognize and quantify MODS in this patient population may provide opportunities for improved resource allocation and timely, organ-specific treatment.<\/jats:p>","DOI":"10.4269\/ajtmh.24-0303","type":"journal-article","created":{"date-parts":[[2024,10,8]],"date-time":"2024-10-08T14:54:39Z","timestamp":1728399279000},"page":"1223-1229","source":"Crossref","is-referenced-by-count":3,"title":["Multiple Organ Dysfunction Syndrome in Malawian Children with Cerebral Malaria"],"prefix":"10.4269","volume":"111","author":[{"given":"Hunter J.","family":"Wynkoop","sequence":"first","affiliation":[{"name":"Division of Pediatric Critical Care Medicine, Department of Pediatrics, Nationwide Children\u2019s Hospital, The Ohio State University, Columbus, Ohio;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alistair","family":"Bevan","sequence":"additional","affiliation":[{"name":"Chesterfield Royal Hospital NHS Foundation Trust, Derbyshire, United Kingdom;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xochilt","family":"Galeano","sequence":"additional","affiliation":[{"name":"Division of Critical Care Medicine, Department of Pediatrics, Hospital Privado Salud Integral, Managua, Nicaragua;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Madiha","family":"Raees","sequence":"additional","affiliation":[{"name":"Division of Critical Care, Department of Anesthesiology and Critical Care, The Children\u2019s Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Md Rejuan","family":"Haque","sequence":"additional","affiliation":[{"name":"Department of Biomedical Informatics, Center for Biostatistics, The Ohio State University, Columbus, Ohio;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Terrie","family":"Taylor","sequence":"additional","affiliation":[{"name":"Department of Osteopathic Medical Specialties, College of Osteopathic Medicine, Michigan State University, East Lansing, Michigan;"},{"name":"Blantyre Malaria Project, Kamuzu University of Health Sciences, Blantyre, Malawi"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nicole F.","family":"O\u2019Brien","sequence":"additional","affiliation":[{"name":"Division of Pediatric Critical Care Medicine, Department of Pediatrics, Nationwide Children\u2019s Hospital, The Ohio State University, Columbus, Ohio;"},{"name":"Blantyre Malaria Project, Kamuzu University of Health Sciences, Blantyre, Malawi"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"2795","reference":[{"key":"b1","series-title":"World Malaria Report 2023","year":"2023"},{"key":"b2","series-title":"Am J Trop Med Hyg","first-page":"1565","article-title":"Malaria in 2022: Challenges and progress","volume":"106","author":"Rosenthal","year":"2022"},{"key":"b3","series-title":"Pediatrics","first-page":"e92","article-title":"Cerebral malaria in children is associated with long-term cognitive impairment","volume":"122","author":"John","year":"2008"},{"key":"b4","series-title":"J Pediatr","first-page":"116","article-title":"Transcranial Doppler ultrasonography provides insights into neurovascular changes in children with cerebral malaria","volume":"203","author":"O\u2019Brien","year":"2018"},{"key":"b5","series-title":"Lancet Neurol","first-page":"827","article-title":"Pathogenesis, clinical features, and neurological outcome of cerebral malaria","volume":"4","author":"Idro","year":"2005"},{"key":"b6","series-title":"Pediatr Res","first-page":"267","article-title":"Cerebral malaria: Mechanisms of brain injury and strategies for improved neurocognitive outcome","volume":"68","author":"Idro","year":"2010"},{"key":"b7","series-title":"Malar J","first-page":"266","article-title":"Pathophysiology and neurologic sequelae of cerebral malaria","volume":"19","author":"Schiess","year":"2020"},{"key":"b8","series-title":"Pediatrics","first-page":"e20181026","article-title":"Neurodevelopmental impairments 1 year after cerebral malaria","volume":"143","author":"Langfitt","year":"2019"},{"key":"b9","series-title":"Crit Care Med","first-page":"2278","article-title":"Severe falciparum malaria: An important cause of multiple organ failure in Indian intensive care unit patients","volume":"31","author":"Krishnan","year":"2003"},{"key":"b10","series-title":"J Neurol Neurosurg Psychiatry","first-page":"433","article-title":"Cerebral malaria","volume":"69","author":"Newton","year":"2000"},{"key":"b11","series-title":"Cold Spring Harb Perspect Med","first-page":"a025569","article-title":"Malaria pathogenesis","volume":"8","author":"Milner","year":"2018"},{"key":"b12","series-title":"N Engl J Med","first-page":"1399","article-title":"Indicators of life-threatening malaria in African children","volume":"332","author":"Marsh","year":"1995"},{"key":"b13","series-title":"Nat Med","first-page":"143","article-title":"Differentiating the pathologies of cerebral malaria by postmortem parasite counts","volume":"10","author":"Taylor","year":"2004"},{"key":"b14","series-title":"J Infect Dis","first-page":"1317","article-title":"Quantitative assessment of multiorgan sequestration of parasites in fatal pediatric cerebral malaria","volume":"212","author":"Milner","year":"2015"},{"key":"b15","series-title":"Clin Infect Dis","first-page":"1511","article-title":"Acute kidney injury interacts with coma, acidosis, and impaired perfusion to significantly increase risk of death in children with severe malaria","volume":"75","author":"Namazzi","year":"2022"},{"key":"b16","series-title":"Semin Respir Crit Care Med","first-page":"543","article-title":"Organ dysfunction: General approach, epidemiology, and organ failure scores","volume":"32","author":"Ferreira","year":"2011"},{"key":"b17","series-title":"Pediatrics","first-page":"S1","article-title":"Pediatric organ dysfunction information update mandate (PODIUM) contemporary organ dysfunction criteria: Executive summary","volume":"149","author":"Bembea","year":"2022"},{"key":"b18","series-title":"Crit Care Med","first-page":"1761","article-title":"PELOD-2: An update of the pediatric logistic organ dysfunction score","volume":"41","author":"Leteurtre","year":"2013"},{"key":"b19","series-title":"Paediatr Indones","first-page":"39","article-title":"New PELOD-2 cut-off score for predicting death in children with sepsis","volume":"61","author":"Suari","year":"2021"},{"key":"b20","series-title":"Int J Contemp Pediatr","first-page":"925","article-title":"Assessment of pSOFA-L score in predicting the clinical outcome of critically ill children","volume":"7","author":"Kumbar","year":"2020"},{"key":"b21","series-title":"An Pediatr (Engl Ed)","first-page":"277","article-title":"Paediatric sequential organ failure assessment (pSOFA) score: A new mortality prediction score in the paediatric intensive care unit [in Spanish]","volume":"92","author":"Mohamed El-Mashad","year":"2020"},{"key":"b22","series-title":"J Postgrad Med","first-page":"102","article-title":"Signs of inflammation in children that can kill (SICK score): Preliminary prospective validation of a new non-invasive measure of severity-of-illness","volume":"52","author":"Bhal","year":"2006"},{"key":"b23","series-title":"Ital J Pediatr","first-page":"35","article-title":"Validation of \u201cSigns of Inflammation in Children that Kill\u201d (SICK) score for immediate non-invasive assessment of severity of illness","volume":"36","author":"Gupta","year":"2010"},{"key":"b24","series-title":"J Infect Dis","first-page":"1834","article-title":"The Lambar\u00e9n\u00e9 Organ Dysfunction Score (LODS) is a simple clinical predictor of fatal malaria in African children","volume":"200","author":"Helbok","year":"2009"},{"key":"b25","series-title":"Crit Care","first-page":"47","article-title":"Prospective validation of pediatric disease severity scores to predict mortality in Ugandan children presenting with malaria and non-malaria febrile illness","volume":"19","author":"Conroy","year":"2015"},{"key":"b26","series-title":"Am J Trop Med Hyg","first-page":"820","article-title":"Multiple organ dysfunction syndrome and pediatric logistic organ dysfunction-2 score in pediatric cerebral malaria","volume":"107","author":"Johnson","year":"2022"},{"key":"b27","series-title":"Trop Parasitol","first-page":"86","article-title":"A study on multi-organ dysfunction syndrome in malaria using sequential organ failure assessment score","volume":"10","author":"Bhutani","year":"2020"},{"key":"b28","series-title":"Przegl Epidemiol","first-page":"215","article-title":"Usefulness of SOFA score and artesunate \u2013 based treatment in severe malaria \u2013 a single center study","volume":"72","author":"Makowiecki","year":"2018"},{"key":"b29","series-title":"Crit Care Med","first-page":"1793","article-title":"Use of the SOFA score to assess the incidence of organ dysfunction\/failure in intensive care units: Results of a multicenter, prospective study","volume":"26","author":"Vincent","year":"1998"},{"key":"b30","series-title":"Malawi Standard Treatment Guidelines","year":"2015"},{"key":"b31","series-title":"Trans R Soc Trop Med Hyg","first-page":"S6","article-title":"Caring for children with cerebral malaria: Insights gleaned from 20 years on a research ward in Malawi","volume":"103","author":"Taylor","year":"2009"},{"key":"b32","series-title":"Pediatr Crit Care Med","first-page":"722","article-title":"Association of organ dysfunction scores and functional outcomes following pediatric critical illness","volume":"20","author":"Matics","year":"2019"},{"key":"b33","series-title":"Pediatr Crit Care Med","first-page":"562","article-title":"Day 1 multiple organ dysfunction syndrome is associated with poor functional outcome and mortality in the pediatric intensive care unit","volume":"10","author":"Typpo","year":"2009"},{"key":"b34","series-title":"Pediatr Crit Care Med","first-page":"333","article-title":"Mortality rates in pediatric septic shock with and without multiple organ system failure","volume":"4","author":"Kutko","year":"2003"},{"key":"b35","series-title":"Lancet","first-page":"192","article-title":"Validation of the Paediatric Logistic Organ Dysfunction (PELOD) score: Prospective, observational, multicentre study","volume":"362","author":"Leteurtre","year":"2003"},{"key":"b36","series-title":"J Pediatr","first-page":"324","article-title":"Mortality associated with multiple organ system failure and sepsis in pediatric intensive care unit","volume":"111","author":"Wilkinson","year":"1987"},{"key":"b37","series-title":"Pediatr Crit Care Med","first-page":"S4","article-title":"Epidemiology and outcomes of pediatric multiple organ dysfunction syndrome","volume":"18","author":"Watson","year":"2017"},{"key":"b38","series-title":"Am J Respir Crit Care Med","first-page":"348","article-title":"Cumulative influence of organ dysfunctions and septic state on mortality of critically ill children","volume":"171","author":"Leclerc","year":"2005"},{"key":"b39","series-title":"Front Pediatr","first-page":"874282","article-title":"Multiple organ dysfunction interactions in critically ill children","volume":"10","author":"Badke","year":"2022"},{"key":"b40","series-title":"Pediatr Crit Care Med","first-page":"S1","article-title":"Multiple organ dysfunction syndrome: A challenge for the pediatric critical care community","volume":"18","author":"Tamburro","year":"2017"},{"key":"b41","year":"2020"},{"key":"b42","series-title":"Trop Med Int Health","first-page":"7","article-title":"Severe malaria","volume":"19","year":"2014"},{"key":"b43","series-title":"Trans R Soc Trop Med Hyg","first-page":"67","article-title":"Lactic acidosis and hypoglycaemia in children with severe malaria: Pathophysiological and prognostic significance","volume":"88","author":"Krishna","year":"1994"},{"key":"b44","series-title":"BMC Nephrol","first-page":"417","article-title":"Methods to estimate baseline creatinine and define acute kidney injury in lean Ugandan children with severe malaria: A prospective cohort study","volume":"21","author":"Batte","year":"2020"},{"key":"b45","series-title":"Kidney Int","first-page":"129","article-title":"Effects of chronic protein-calorie malnutrition on the kidney","volume":"3","author":"Klahr","year":"1973"},{"key":"b46","series-title":"Nephron Clin Pract","first-page":"c179","article-title":"KDIGO clinical practice guidelines for acute kidney injury","volume":"120","author":"Khwaja","year":"2012"},{"key":"b47","series-title":"J Clin Sci Res","first-page":"S1","article-title":"Thrombocytopenia in malaria and its diagnostic significance: A prospective study","volume":"12","author":"Krishna","year":"2023"},{"key":"b48","series-title":"Mem Inst Oswaldo Cruz","first-page":"52","article-title":"Thrombocytopenia in malaria: Who cares?","volume":"106","author":"Lacerda","year":"2011"},{"key":"b49","series-title":"Interdiscip Perspect Infect Dis","first-page":"5954394","article-title":"Parasitaemia and its relation to hematological parameters and liver function among patients malaria in Abs, Hajjah, northwest Yemen","volume":"2016","author":"Al-Salahy","year":"2016"},{"key":"b50","series-title":"J Gastroenterol Hepatol","first-page":"1322","article-title":"Jaundice in malaria","volume":"20","author":"Anand","year":"2005"},{"key":"b51","series-title":"Med J Dr DY Patil Univ","first-page":"21","article-title":"Abnormalities of liver function tests in acute malaria with hepatic involvement: A case\u2013control study in eastern India","volume":"14","author":"Bhattacharjee","year":"2021"},{"key":"b52","series-title":"Intensive Care Med","first-page":"523","article-title":"External confirmation and exploration of the Kigali modification for diagnosing moderate or severe ARDS","volume":"44","author":"Vercesi","year":"2018"},{"key":"b53","series-title":"Crit Care Med","first-page":"1309","article-title":"Comparison of SpO2 to PaO2 based markers of lung disease severity for children with acute lung injury","volume":"40","author":"Khemani","year":"2012"}],"container-title":["The American Journal of Tropical Medicine and Hygiene"],"original-title":[],"link":[{"URL":"https:\/\/www.ajtmh.org\/view\/journals\/tpmd\/111\/6\/article-p1223.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.ajtmh.org\/downloadpdf\/journals\/tpmd\/111\/6\/article-p1223.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/www.ajtmh.org\/downloadpdf\/journals\/tpmd\/111\/6\/article-p1223.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,12,4]],"date-time":"2024-12-04T15:28:31Z","timestamp":1733326111000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ajtmh.org\/view\/journals\/tpmd\/111\/6\/article-p1223.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,12,4]]},"references-count":53,"journal-issue":{"issue":"6"},"URL":"https:\/\/doi.org\/10.4269\/ajtmh.24-0303","relation":{},"ISSN":["0002-9637","1476-1645"],"issn-type":[{"value":"0002-9637","type":"print"},{"value":"1476-1645","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,12,4]]}}}