Acute renal failure in severe falciparum malaria patients in an intensive care unit in Malaysia

Objectives: Identify the risk factors and the clinical impact of ARF in patients with severe falciparum malaria.

Method: Intensive care unit cases of severe falciparum malaria of Sarawak General Hospital were analysed.

Results: Out of 40 cases of severe falciparum malaria, 19 developed ARF. Patients with ARF were older (p=0·030), had higher AST (p=0·014), higher unconjugated bilirubin (p=0·041), and lower globulin (p=0·015). Aspartate transaminase level positively correlated with creatinine and urea level (log AST and urea: r=0·464, p=0·004; log AST and log creatinine: r=0·430, p=0·008); while unconjugated bilirubin level positively correlated with creatinine level with geometric transformation (r=0·402, p=0·020). Patients with ARF have higher mortality (p=0·004),and more failing organs (p = 0·0003). Patients with ARF that died had a higher number of organs failing compared with those that survived (p=0·043). Among patients with total parasite count of >300,000/µL, those patients treated with dialysis, haemofiltration or exchange transfusion developed less organ failure (p=0·050). Logistic regression with adjustment for age and malarial complications identified ARF to be the major predictor of mortality.

Conclusions: 1) Patients with severe falciparum malaria who developed ARF have higher rate of haemolysis, more organs failing and higher mortality rate. 2) Dialysis, haemofiltration or exchange transfusion may reduced the rate of organ failure among patients with parasite count >300000/µL.