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Cardiac function in Ghanaian children with severe malaria

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Abstract

Purpose

The aim was to assess whether impaired cardiac function contributes to symptoms of severe malaria in general or to metabolic acidosis in particular in children living in endemic regions.

Methods

In a prospective observational investigation, 183 children with severe malaria were investigated for hemodynamic status and cardiac function upon admission (day 0) and after recovery (day 42). Cardiac function parameters were assessed by cardiac ultrasonography. Blood gas analyses and cardiac enzymes were measured at hospitalization and follow-up. Differences in subgroups with and without metabolic acidosis as well as other severe malaria-defining symptoms and conditions were assessed.

Results

Cardiac index (CI) was significantly increased on day 0 compared to day 42 (5.8 ml/m2, SD ± 1.8 ml/m2, versus 4.7 ml/m2, SD ± 1.4 ml/m2; P < 0.001). CI correlated negatively with hemoglobin levels but not with parameters indicating impaired tissue perfusion or metabolic acidosis. Parasite levels had a significant influence on metabolic acidosis but not on CI. Alterations related to cardiac function, hemoglobin levels and metabolic acidosis were most prominent in children younger than 2 years.

Conclusion

Increased CI reflecting high output status is associated with low hemoglobin levels while metabolic acidosis is linked to parasite levels.

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Acknowledgments

We thank all participating children and their parents. This study formed part of the doctoral theses of S.H. and D.P. Part of this work was presented at the 59th Annual Meeting of the American Society of Tropical Medicine and Hygiene, Atlanta, Georgia, 3–7 November 2010. This work was supported by the Else Kröner-Fresenius-Stiftung (P18/08//A01/08).

Conflicts of interest

None.

Author information

Authors and Affiliations

  1. Paediatric Emergency Unit, Department of Child Health, Komfo Anokye Teaching Hospital, Kumasi, Ghana

    Samuel B. Nguah, Daniel Ansong & Justice Sylverken

  2. School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana

    Samuel B. Nguah & Daniel Ansong

  3. Department Clinical Research, Bernhard Nocht Institute of Tropical Medicine, Hamburg, Germany

    Torsten Feldt, Stephan Ehrhardt, Gerd D. Burchard & Jakob P. Cramer

  4. Kumasi Centre for Collaborative Research in Tropical Medicine (KCCR), Kumasi, Ghana

    Torsten Feldt

  5. Section Tropical Medicine, Department of Tropical Medicine, Bernhard Nocht Clinic, University Medical Centre Hamburg-Eppendorf, Bernhard-Nocht-Strasse 74, 20359, Hamburg, Germany

    Steffi Hoffmann, Daniel Pelletier, Parisa Mehrfar, Johanna Herr, Gerd D. Burchard & Jakob P. Cramer

  6. Department of Pediatric Cardiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

    Christian Thiel

  7. Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA

    Stephan Ehrhardt

Authors
  1. Samuel B. Nguah
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  2. Torsten Feldt
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  3. Steffi Hoffmann
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  4. Daniel Pelletier
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  5. Daniel Ansong
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  6. Justice Sylverken
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  7. Parisa Mehrfar
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  8. Johanna Herr
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  9. Christian Thiel
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  10. Stephan Ehrhardt
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  11. Gerd D. Burchard
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  12. Jakob P. Cramer
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Corresponding author

Correspondence to Jakob P. Cramer.

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Nguah, S.B., Feldt, T., Hoffmann, S. et al. Cardiac function in Ghanaian children with severe malaria. Intensive Care Med 38, 2032–2041 (2012). https://doi.org/10.1007/s00134-012-2676-z

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  • DOI: https://doi.org/10.1007/s00134-012-2676-z

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