Multiple Organ Dysfunction and PELOD-2 Score in Pediatric Cerebral Malaria
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Infection, Sepsis, Pediatrics, 2022
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INTRODUCTION/HYPOTHESIS: Globally, malaria results in 409,000 deaths annually, the majority of which occur in children less than five years of age. Cerebral malaria (CM) is the most severe manifestation of the disease with case fatality rates of up to 40%. Autopsy results in children with CM have demonstrated sequestration of Plasmodium falciparum parasites not only within the brain, but also in the heart, lungs, spleen, stomach, intestines, and skin. Thus, it is plausible that multiple organ dysfunction syndrome (MODS) is present in pediatric patients with CM, but the frequency of MODS and its association with mortality in this patient population has not been well described. METHODS: This is a retrospective review of prospectively gathered data in children 6 months to 12 years of age admitted to Queen Elizabeth Central Hospital in Blantyre, Malawi between January 2019 and June 2021. All patients met the World Health Organization case definition for CM. Physical exam findings and laboratory values necessary to calculate a Pediatric Organ Logistic Dysfunction-2 (PELOD-2) score were abstracted. RESULTS: A total of 138 patients were included with a mean age of 59 months. Overall mortality for the cohort was 15% (n=20). Only 7 patients (5%) had single organ dysfunction, while 34 (25%) had two organs involved, 66 (48%) had dysfunction of three organs, and the remaining 31 (22%) patients had four organs affected. In addition to neurologic dysfunction, other organ systems involved included hematologic (80%), renal (62%), cardiovascular (45%), and respiratory (1%). The mean PELOD-2 score on admission was 4.7 (±2.3) in those who survived to discharge and 7.4 (±3.2) in the patients who died (p < 0.0001). An ROC analysis showed that admission PELOD-2 score predicted mortality with an AUC of 0.77. CONCLUSIONS: Multiple organ dysfunction is nearly ubiquitous in pediatric patients with cerebral malaria. PELOD-2 score at the time of hospital admission may objectively identify children with CM at highest risk of mortality allowing for the allocation of limited resources.
Meta Tag
Content Type Presentation
Knowledge Area Infection
Knowledge Area Sepsis
Knowledge Area Pediatrics
Knowledge Level Advanced
Membership Level Select
Tag Infectious Diseases
Tag Multiple Organ Dysfunction
Tag Pediatrics
Tag Tropical Medicine
Year 2022
Pediatric Critical Care Medicine Fellow
multiple organ dysfunction syndrome
pediatric cerebral malaria
retrospective study
PILAD2 score


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