Unidentified acids of strong prognostic significance in severe malaria
OBJECTIVE:To calculate, using the Stewart approach to acid-base disorders, the strong anion gap as an estimate for the contribution of unmeasured plasma anions other than lactate to the metabolic acidosis that characterizes severe falciparum malaria and to assess its relative prognostic significance...
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| Veröffentlicht in: | Critical care medicine 2004-08, Vol.32 (8), p.1683-1688 |
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| creator | Dondorp, Arjen M Chau, Tran Thi Hong Phu, Nguyen Hoan Mai, Nguyen Thi Hoang Loc, Pham Phu Chuong, Ly Van Sinh, Dinh Xuan Taylor, Ann Hien, Tran Tinh White, Nicholas J Day, Nicholas P. J |
| description | OBJECTIVE:To calculate, using the Stewart approach to acid-base disorders, the strong anion gap as an estimate for the contribution of unmeasured plasma anions other than lactate to the metabolic acidosis that characterizes severe falciparum malaria and to assess its relative prognostic significance.
DESIGN:Cohort study.
SETTING:The intensive care unit of an infectious diseases hospital in southern Vietnam.
PATIENTS:Consecutive adult patients (n = 268) with severe falciparum malaria.
INTERVENTIONS:The intervention was clinical management in a dedicated unit. We measured baseline venous lactate, electrolytes, biochemical variables, admission arterial blood pH, and gas tensions for calculation of the strong anion gap.
MEASUREMENTS AND MAIN RESULTS:The mean (95% confidence interval) admission strong anion gap was 11.1 (10.4–11.9) mEq/L, compared with lactate (geometric mean, 95% confidence interval) at 2.9 (2.7–3.2) mmol/L. Strong anion gap had a high predictive value for mortality (area under the receiver operating characteristic curve 0.73 (95% confidence interval, 0.65–0.82), which was independent of plasma lactate and creatinine concentrations. Renal failure and hepatic dysfunction were both associated with, but were not the sole determinants of, high levels of strong anion gap.
CONCLUSIONS:In severe malaria, unidentified anions other than lactate are the most important contributors to metabolic acidosis, a major cause of death. The strong anion gap is a powerful prognostic indicator in patients with severe malaria. |
| doi_str_mv | 10.1097/01.CCM.0000132901.86681.CA |
| format | Article |
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DESIGN:Cohort study.
SETTING:The intensive care unit of an infectious diseases hospital in southern Vietnam.
PATIENTS:Consecutive adult patients (n = 268) with severe falciparum malaria.
INTERVENTIONS:The intervention was clinical management in a dedicated unit. We measured baseline venous lactate, electrolytes, biochemical variables, admission arterial blood pH, and gas tensions for calculation of the strong anion gap.
MEASUREMENTS AND MAIN RESULTS:The mean (95% confidence interval) admission strong anion gap was 11.1 (10.4–11.9) mEq/L, compared with lactate (geometric mean, 95% confidence interval) at 2.9 (2.7–3.2) mmol/L. Strong anion gap had a high predictive value for mortality (area under the receiver operating characteristic curve 0.73 (95% confidence interval, 0.65–0.82), which was independent of plasma lactate and creatinine concentrations. Renal failure and hepatic dysfunction were both associated with, but were not the sole determinants of, high levels of strong anion gap.
CONCLUSIONS:In severe malaria, unidentified anions other than lactate are the most important contributors to metabolic acidosis, a major cause of death. The strong anion gap is a powerful prognostic indicator in patients with severe malaria.</description><identifier>ISSN: 0090-3493</identifier><identifier>EISSN: 1530-0293</identifier><identifier>DOI: 10.1097/01.CCM.0000132901.86681.CA</identifier><identifier>PMID: 15286544</identifier><identifier>CODEN: CCMDC7</identifier><language>eng</language><publisher>Hagerstown, MD: by the Society of Critical Care Medicine and Lippincott Williams & Wilkins</publisher><subject>Acid-Base Equilibrium ; Acidosis - blood ; Acidosis - etiology ; Acidosis - physiopathology ; Adolescent ; Adult ; Aged ; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy ; Biological and medical sciences ; Cohort Studies ; Creatinine - blood ; Critical Care - methods ; Female ; Humans ; Intensive care medicine ; Lactic Acid - blood ; Malaria, Falciparum - blood ; Malaria, Falciparum - complications ; Malaria, Falciparum - diagnosis ; Malaria, Falciparum - mortality ; Male ; Medical sciences ; Middle Aged ; Multivariate Analysis ; Phosphates - blood ; Predictive Value of Tests ; Prognosis ; Prospective Studies ; Survival Analysis ; Vietnam - epidemiology</subject><ispartof>Critical care medicine, 2004-08, Vol.32 (8), p.1683-1688</ispartof><rights>2004 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins</rights><rights>2004 INIST-CNRS</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3908-7dd33ae21fab438068fd73b505f3d808403bb6e115537376cfab381dda13f8d03</citedby><cites>FETCH-LOGICAL-c3908-7dd33ae21fab438068fd73b505f3d808403bb6e115537376cfab381dda13f8d03</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=16035548$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/15286544$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Dondorp, Arjen M</creatorcontrib><creatorcontrib>Chau, Tran Thi Hong</creatorcontrib><creatorcontrib>Phu, Nguyen Hoan</creatorcontrib><creatorcontrib>Mai, Nguyen Thi Hoang</creatorcontrib><creatorcontrib>Loc, Pham Phu</creatorcontrib><creatorcontrib>Chuong, Ly Van</creatorcontrib><creatorcontrib>Sinh, Dinh Xuan</creatorcontrib><creatorcontrib>Taylor, Ann</creatorcontrib><creatorcontrib>Hien, Tran Tinh</creatorcontrib><creatorcontrib>White, Nicholas J</creatorcontrib><creatorcontrib>Day, Nicholas P. J</creatorcontrib><title>Unidentified acids of strong prognostic significance in severe malaria</title><title>Critical care medicine</title><addtitle>Crit Care Med</addtitle><description>OBJECTIVE:To calculate, using the Stewart approach to acid-base disorders, the strong anion gap as an estimate for the contribution of unmeasured plasma anions other than lactate to the metabolic acidosis that characterizes severe falciparum malaria and to assess its relative prognostic significance.
DESIGN:Cohort study.
SETTING:The intensive care unit of an infectious diseases hospital in southern Vietnam.
PATIENTS:Consecutive adult patients (n = 268) with severe falciparum malaria.
INTERVENTIONS:The intervention was clinical management in a dedicated unit. We measured baseline venous lactate, electrolytes, biochemical variables, admission arterial blood pH, and gas tensions for calculation of the strong anion gap.
MEASUREMENTS AND MAIN RESULTS:The mean (95% confidence interval) admission strong anion gap was 11.1 (10.4–11.9) mEq/L, compared with lactate (geometric mean, 95% confidence interval) at 2.9 (2.7–3.2) mmol/L. Strong anion gap had a high predictive value for mortality (area under the receiver operating characteristic curve 0.73 (95% confidence interval, 0.65–0.82), which was independent of plasma lactate and creatinine concentrations. Renal failure and hepatic dysfunction were both associated with, but were not the sole determinants of, high levels of strong anion gap.
CONCLUSIONS:In severe malaria, unidentified anions other than lactate are the most important contributors to metabolic acidosis, a major cause of death. The strong anion gap is a powerful prognostic indicator in patients with severe malaria.</description><subject>Acid-Base Equilibrium</subject><subject>Acidosis - blood</subject><subject>Acidosis - etiology</subject><subject>Acidosis - physiopathology</subject><subject>Adolescent</subject><subject>Adult</subject><subject>Aged</subject><subject>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</subject><subject>Biological and medical sciences</subject><subject>Cohort Studies</subject><subject>Creatinine - blood</subject><subject>Critical Care - methods</subject><subject>Female</subject><subject>Humans</subject><subject>Intensive care medicine</subject><subject>Lactic Acid - blood</subject><subject>Malaria, Falciparum - blood</subject><subject>Malaria, Falciparum - complications</subject><subject>Malaria, Falciparum - diagnosis</subject><subject>Malaria, Falciparum - mortality</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Multivariate Analysis</subject><subject>Phosphates - blood</subject><subject>Predictive Value of Tests</subject><subject>Prognosis</subject><subject>Prospective Studies</subject><subject>Survival Analysis</subject><subject>Vietnam - epidemiology</subject><issn>0090-3493</issn><issn>1530-0293</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2004</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpFkE1v1DAQQK0K1C6Fv4AiJHrLMs7YjsNtFVFaqYgLPVuOPd4askmxs1T8-7rdlXYuoxm9-dBj7BOHNYeu_QJ83fc_1lCCY9OVUiulS3NzxlZcItTQdPiGrQA6qFF0eMHe5fy74EK2eM4uuGy0kkKs2PX9FD1NSwyRfGVd9LmaQ5WXNE_b6jHN22nOS3RVjtupQM5Ojqo4VZn-UaJqZ0ebon3P3gY7ZvpwzJfs_vrbr_6mvvv5_bbf3NUOO9B16z2ipYYHOwjUoHTwLQ4SZECvQQvAYVDEuZTYYqtc4VBz7y3HoD3gJbs67C2f_d1TXswuZkfjaCea99ko1UotNC_g1wPo0pxzomAeU9zZ9N9wMC8WDXBTLJqTRfNq0fSbMvzxeGU_7MifRo_aCvD5CNjs7BhSsRLziVOAUgpdOHHgnuZxoZT_jPsnSuaB7Lg8vJ7GRqi6ARCgS1W_tDQ-A6tkimY</recordid><startdate>200408</startdate><enddate>200408</enddate><creator>Dondorp, Arjen M</creator><creator>Chau, Tran Thi Hong</creator><creator>Phu, Nguyen Hoan</creator><creator>Mai, Nguyen Thi Hoang</creator><creator>Loc, Pham Phu</creator><creator>Chuong, Ly Van</creator><creator>Sinh, Dinh Xuan</creator><creator>Taylor, Ann</creator><creator>Hien, Tran Tinh</creator><creator>White, Nicholas J</creator><creator>Day, Nicholas P. J</creator><general>by the Society of Critical Care Medicine and Lippincott Williams & Wilkins</general><general>Lippincott</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>200408</creationdate><title>Unidentified acids of strong prognostic significance in severe malaria</title><author>Dondorp, Arjen M ; Chau, Tran Thi Hong ; Phu, Nguyen Hoan ; Mai, Nguyen Thi Hoang ; Loc, Pham Phu ; Chuong, Ly Van ; Sinh, Dinh Xuan ; Taylor, Ann ; Hien, Tran Tinh ; White, Nicholas J ; Day, Nicholas P. J</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3908-7dd33ae21fab438068fd73b505f3d808403bb6e115537376cfab381dda13f8d03</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2004</creationdate><topic>Acid-Base Equilibrium</topic><topic>Acidosis - blood</topic><topic>Acidosis - etiology</topic><topic>Acidosis - physiopathology</topic><topic>Adolescent</topic><topic>Adult</topic><topic>Aged</topic><topic>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</topic><topic>Biological and medical sciences</topic><topic>Cohort Studies</topic><topic>Creatinine - blood</topic><topic>Critical Care - methods</topic><topic>Female</topic><topic>Humans</topic><topic>Intensive care medicine</topic><topic>Lactic Acid - blood</topic><topic>Malaria, Falciparum - blood</topic><topic>Malaria, Falciparum - complications</topic><topic>Malaria, Falciparum - diagnosis</topic><topic>Malaria, Falciparum - mortality</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Multivariate Analysis</topic><topic>Phosphates - blood</topic><topic>Predictive Value of Tests</topic><topic>Prognosis</topic><topic>Prospective Studies</topic><topic>Survival Analysis</topic><topic>Vietnam - epidemiology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Dondorp, Arjen M</creatorcontrib><creatorcontrib>Chau, Tran Thi Hong</creatorcontrib><creatorcontrib>Phu, Nguyen Hoan</creatorcontrib><creatorcontrib>Mai, Nguyen Thi Hoang</creatorcontrib><creatorcontrib>Loc, Pham Phu</creatorcontrib><creatorcontrib>Chuong, Ly Van</creatorcontrib><creatorcontrib>Sinh, Dinh Xuan</creatorcontrib><creatorcontrib>Taylor, Ann</creatorcontrib><creatorcontrib>Hien, Tran Tinh</creatorcontrib><creatorcontrib>White, Nicholas J</creatorcontrib><creatorcontrib>Day, Nicholas P. J</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Critical care medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Dondorp, Arjen M</au><au>Chau, Tran Thi Hong</au><au>Phu, Nguyen Hoan</au><au>Mai, Nguyen Thi Hoang</au><au>Loc, Pham Phu</au><au>Chuong, Ly Van</au><au>Sinh, Dinh Xuan</au><au>Taylor, Ann</au><au>Hien, Tran Tinh</au><au>White, Nicholas J</au><au>Day, Nicholas P. J</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Unidentified acids of strong prognostic significance in severe malaria</atitle><jtitle>Critical care medicine</jtitle><addtitle>Crit Care Med</addtitle><date>2004-08</date><risdate>2004</risdate><volume>32</volume><issue>8</issue><spage>1683</spage><epage>1688</epage><pages>1683-1688</pages><issn>0090-3493</issn><eissn>1530-0293</eissn><coden>CCMDC7</coden><abstract>OBJECTIVE:To calculate, using the Stewart approach to acid-base disorders, the strong anion gap as an estimate for the contribution of unmeasured plasma anions other than lactate to the metabolic acidosis that characterizes severe falciparum malaria and to assess its relative prognostic significance.
DESIGN:Cohort study.
SETTING:The intensive care unit of an infectious diseases hospital in southern Vietnam.
PATIENTS:Consecutive adult patients (n = 268) with severe falciparum malaria.
INTERVENTIONS:The intervention was clinical management in a dedicated unit. We measured baseline venous lactate, electrolytes, biochemical variables, admission arterial blood pH, and gas tensions for calculation of the strong anion gap.
MEASUREMENTS AND MAIN RESULTS:The mean (95% confidence interval) admission strong anion gap was 11.1 (10.4–11.9) mEq/L, compared with lactate (geometric mean, 95% confidence interval) at 2.9 (2.7–3.2) mmol/L. Strong anion gap had a high predictive value for mortality (area under the receiver operating characteristic curve 0.73 (95% confidence interval, 0.65–0.82), which was independent of plasma lactate and creatinine concentrations. Renal failure and hepatic dysfunction were both associated with, but were not the sole determinants of, high levels of strong anion gap.
CONCLUSIONS:In severe malaria, unidentified anions other than lactate are the most important contributors to metabolic acidosis, a major cause of death. The strong anion gap is a powerful prognostic indicator in patients with severe malaria.</abstract><cop>Hagerstown, MD</cop><pub>by the Society of Critical Care Medicine and Lippincott Williams & Wilkins</pub><pmid>15286544</pmid><doi>10.1097/01.CCM.0000132901.86681.CA</doi><tpages>6</tpages></addata></record> |
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| ispartof | Critical care medicine, 2004-08, Vol.32 (8), p.1683-1688 |
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| subjects | Acid-Base Equilibrium Acidosis - blood Acidosis - etiology Acidosis - physiopathology Adolescent Adult Aged Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy Biological and medical sciences Cohort Studies Creatinine - blood Critical Care - methods Female Humans Intensive care medicine Lactic Acid - blood Malaria, Falciparum - blood Malaria, Falciparum - complications Malaria, Falciparum - diagnosis Malaria, Falciparum - mortality Male Medical sciences Middle Aged Multivariate Analysis Phosphates - blood Predictive Value of Tests Prognosis Prospective Studies Survival Analysis Vietnam - epidemiology |
| title | Unidentified acids of strong prognostic significance in severe malaria |
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