Metabolic Acidosis and Uremia as Prognostic Markers in Pediatric Patients with Complicated Plasmodium falciparum Malaria Admitted to a Tertiary Care Center

BACKGROUND: Complicated Plasmodium falciparum malaria remains a major cause of pediatric morbidity and mortality in endemic regions. Metabolic acidosis and uremia are important biochemical abnormalities associated with severe malaria, but their prognostic significance in children has not been adequately studied. INTRODUCTION: Malaria remains a major cause of illness and death among children in endemic regions, with Plasmodium falciparum responsible for the most severe forms. Complicated malaria is defined by clinical or laboratory features such as metabolic acidosis, renal dysfunction, shock, or impaired consciousness. Early identification of high-risk children is important, particularly in resource-limited settings. Metabolic acidosis and uraemia are common findings but are not routinely used as prognostic indicators. This study evaluates their association with mortality, complications, and duration of hospital stay in children with complicated P. falciparum malaria. METHODS: This cross-sectional study was conducted at RIMS, Ranchi, from June 2022 to May 2024, and included 104 children aged 1-18 years with confirmed complicated P. falciparum malaria. Clinical, biochemical, and outcome data were collected. Associations between metabolic acidosis, uraemia, and clinical outcomes were assessed using odds ratios and chi-square tests. RESULTS: Metabolic acidosis was present in 50% of patients and uraemia in 24%. Mortality was higher in those with metabolic acidosis (25%) and uraemia (24%) compared to children without either (6.12%). Metabolic acidosis showed significant associations with anemia, impaired consciousness, respiratory distress, shock, hypoglycemia, and longer hospital stay. Uraemia was associated with anemia, impaired consciousness, jaundice, shock, and hypoglycemia but not with hospital stay. CONCLUSION: Metabolic acidosis and uraemia serve as important prognostic markers in complicated P. falciparum malaria and are linked to higher mortality and severe complications.