Evidence map›Paper›PMID 34172046›Full record

Trial reportMalaria journal2021

Identifying prognostic factors of severe metabolic acidosis and uraemia in African children with severe falciparum malaria: a secondary analysis of a randomized trial.

Grace Mzumara, Stije Leopold, Kevin Marsh, Arjen Dondorp, Eric O Ohuma, Mavuto Mukaka

Open access · goldAbstract readMulticenter StudyRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in Malaria journal, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers.

0numbers the graph read from it
0cells of the map it votes in
5citing papers in PubMed
1.0field-weighted citation impact, top 24% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

5 citing papers in PubMed, 9 citations in OpenAlex.

  1. Article
  2. Malaria-Associated Acute Kidney Injury: A Key Driver of Mortality in Endemic Regions.International journal of nephrology and renovascular disease · 2026
    Review
  3. Review
  4. Article
  5. Acute Kidney Injury Interacts With Coma, Acidosis, and Impaired Perfusion to Significantly Increase Risk of Death in Children With Severe Malaria.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2022
    Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

6 authors at 5 institutions in 5 countries.

Grace MzumaraMalawi Liverpool Wellcome Trust, Queen Elizabeth Central Hospital College of Medicine, Chichiri 3, P.O. Box 30096, Blantyre, Malawi. gmzumara@mlw.mw.ORCID http://orcid.org/0000-0001-8132-1620
Stije LeopoldCentre for Tropical Medicine and Global Health, Oxford, UK.
Kevin MarshCentre for Tropical Medicine and Global Health, Oxford, UK.
Arjen DondorpCentre for Tropical Medicine and Global Health, Oxford, UK.
Eric O Ohuma *University of Oxford, Oxford, UK.
Mavuto Mukaka *University of Malawi, College of Medicine, Blantyre, Malawi.
Mahidol Oxford Tropical Medicine Research Unit · THKenya Medical Research Institute · KEUniversity of Liverpool · GBUniversity of Malawi · MWUniversity of Oxford · GB

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundSevere metabolic acidosis and acute kidney injury are major causes of mortality in children with severe malaria but are often underdiagnosed in low resource settings.

methodsA retrospective analysis of the 'Artesunate versus quinine in the treatment of severe falciparum malaria in African children' (AQUAMAT) trial was conducted to identify clinical features of severe metabolic acidosis and uraemia in 5425 children from nine African countries. Separate models were fitted for uraemia and severe metabolic acidosis. Separate univariable and multivariable logistic regression were performed to identify prognostic factors for severe metabolic acidosis and uraemia. Both analyses adjusted for the trial arm. A forward selection approach was used for model building of the logistic models and a threshold of 5% statistical significance was used for inclusion of variables into the final logistic model. Model performance was assessed through calibration, discrimination, and internal validation with bootstrapping.

resultsThere were 2296 children identified with severe metabolic acidosis and 1110 with uraemia. Prognostic features of severe metabolic acidosis among them were deep breathing (OR: 3.94, CI 2.51-6.2), hypoglycaemia (OR: 5.16, CI 2.74-9.75), coma (OR: 1.72 CI 1.17-2.51), respiratory distress (OR: 1.46, CI 1.02-2.1) and prostration (OR: 1.88 CI 1.35-2.59). Features associated with uraemia were coma (3.18, CI 2.36-4.27), Prostration (OR: 1.78 CI 1.37-2.30), decompensated shock (OR: 1.89, CI 1.31-2.74), black water fever (CI 1.58. CI 1.09-2.27), jaundice (OR: 3.46 CI 2.21-5.43), severe anaemia (OR: 1.77, CI 1.36-2.29) and hypoglycaemia (OR: 2.77, CI 2.22-3.46)

conclusionClinical and laboratory parameters representing contributors and consequences of severe metabolic acidosis and uraemia were independently associated with these outcomes. The model can be useful for identifying patients at high risk of these complications where laboratory assessments are not routinely available.

Indexed as

AcidosisAfrica South of the SaharaChildChild, PreschoolDemocratic Republic of the CongoFemaleGambiaGhanaHumansInfantKenyaMalaria, FalciparumMaleMozambiqueNigeriaPrognosisAcute kidney injuryAfricaMetabolic acidosisPlasmodium falciparumSevere malaria

Identifiers

PMID34172046
PMCPMC8234663
OpenAlexW3124115035

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.