A Risk Scoring System for Predicting Clinical Deterioration in Patients with Malaria Treated with Intravenous Artesunate

Background: Intravenous artesunate is the first-line treatment for severe malaria; however, clinical deterioration may occur during treatment.This study aimed to identify risk factors associated with clinical deterioration and to construct a risk-scoring system.Methods: We retrospectively reviewed medical records of adult patients who received at least one dose of intravenous artesunate for malaria at the National Medical Center between January 2014 and December 2023.Clinical deterioration was defined as the new onset of any severe malaria symptom after artesunate administration.Multivariable logistic regression analysis was conducted to identify independent predictors.Results: Among 98 patients included in the final analysis, 29 (29.6%)experienced clinical deterioration.Multivariable analysis revealed that female sex (adjusted odds ratio (aOR) 4.3, 95% confidence interval (CI) 1.0-19.0),age 60 years (aOR 3.4, 95% CI 0.8-14.3),presence of jaundice at admission (aOR 4.3, 95% CI 1.1-16.5),and elevated alanine aminotransferase (ALT) level (aOR 2.6, 95% CI 1.0-6.8)were independently associated with increased risk of clinical deterioration.Based on these factors, a risk scoring system (range: 0-5 points) was constructed and showed a stepwise increase in deterioration risk by score.Conclusions: Female sex, advanced age, jaundice, and elevated ALT were independent predictors of clinical deterioration in malaria patients treated with artesunate.The proposed risk score may aid in early identification of high-risk patients and guide clinical decision-making.