Navigating mortality prediction in severe malaria: risk stratification models from the emergency department of coastal India

INTRODUCTION: Malaria, a pervasive infectious disease, remains a critical health concern worldwide, particularly in regions with high transmission rates. This study investigates demographic patterns and prognostic factors influencing outcomes in malaria patients presenting to the emergency department (ED). MATERIAL AND METHODS: This retrospective cross-sectional study, conducted at ED of South coastal India, from September 1, 2017, to September 1, 2022, analysed data from approximately 12,000 annual visits. Mortality predictors were assessed in malaria-positive patients, including Shock Index (SI), Modified Early Warning Score (MEWS), Sequential Organ Failure Assessment (SOFA), Malaria Severity Index (MSA), Malaria Prognostic Score (MPS), Coma Acidosis Malaria (CAM) score, Respiratory and Bicarbonate-based CAM score (R-CAM and B-CAM), Glasgow Coma Scale (GCS), and GCRBS Score. RESULT: Analysis of 114 severe malaria cases revealed higher mortality (21.1%) among older rural patients. Non-survivors exhibited elevated pulse rates (139.83 ± 7.43), lower blood pressure (systolic: 62.58 ± 28.27, diastolic: 47.33 ± 20.73), and impaired consciousness (GCS: 6.63 ± 1.69). GCRBS, MSA, and SOFA scores demonstrated exceptional predictive accuracy (AUC = 1.00). CONCLUSIONS: Identifying crucial mortality predictors like MSA, MPS, CAM, and GCRBS scores in malaria patients can optimize ED management protocols effectively.