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Blood glucose and prognosis in children with presumed severe malaria: is there a threshold for ‘hypoglycaemia’?
Author(s) -
Willcox Merlin L.,
Forster Mathieu,
Dicko Moussa I.,
Graz Bertrand,
MayonWhite Richard,
Barennes Hubert
Publication year - 2010
Publication title -
tropical medicine and international health
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.056
H-Index - 114
eISSN - 1365-3156
pISSN - 1360-2276
DOI - 10.1111/j.1365-3156.2009.02444.x
Subject(s) - medicine , malaria , odds ratio , case fatality rate , logistic regression , hypoglycemia , gastroenterology , receiver operating characteristic , prospective cohort study , epidemiology , immunology , insulin
Summary Objectives Hypoglycaemia (glucose <2.2 mmol/l) is a defining feature of severe malaria, but the significance of other levels of blood glucose has not previously been studied in children with severe malaria. Methods A prospective study of 437 consecutive children with presumed severe malaria was conducted in Mali. We defined hypoglycaemia as <2.2 mmol/l, low glycaemia as 2.2–4.4 mmol/l and hyperglycaemia as >8.3 mmol/l. Associations between glycaemia and case fatality were analysed for 418 children using logistic regression models and a receiver operator curve (ROC). Results There was a significant difference between blood glucose levels in children who died (median 4.6 mmol/l) and survivors (median 7.6 mmol/l, P < 0.001). Case fatality declined from 61.5% of the hypoglycaemic children to 46.2% of those with low glycaemia, 13.4% of those with normal glycaemia and 7.6% of those with hyperglycaemia ( P < 0.001). Logistic regression showed an adjusted odds ratio (AOR) of 0.75 (0.64–0.88) for case fatality per 1 mmol/l increase in baseline blood glucose. Compared to a normal blood glucose, hypoglycaemia and low glycaemia both significantly increased the odds of death (AOR 11.87, 2.10–67.00; and 5.21, 1.86–14.63, respectively), whereas hyperglycaemia reduced the odds of death (AOR 0.34, 0.13–0.91). The ROC [area under the curve at 0.753 (95% CI 0.684–0.820)] indicated that glycaemia had a moderate predictive value for death and identified an optimal threshold at glycaemia <6.1 mmol/l, (sensitivity 64.5% and specificity 75.1%). Conclusions If there is a threshold of blood glucose which defines a worse prognosis, it is at a higher level than the current definition of 2.2 mmol/l.