Adrenal Insufficiency in Severe Falciparum Malaria: Its Outcome and Prediction by Discriminant Score

ABSTRACT

Introduction: Severe falciparum malaria (SFM) is acomplex syndrome which affect different organs of the bodywith variable severity. But adrenal insufficiency (AI) isa less described entity in SFM. The present study aimed atdescribing AI, its prediction with Discriminant Score (DS),effect of replacement of hydrocortisone in such cases.Material and Methods: This study was conducted in twosteps among two cohort of patients. In Step-1, AI has beendetected by cortisol assay among 142 consecutive cases ofSFM. Taking different clinical and biochemical variables,Discriminant Function Analysis was performed to find out aDS to predict AI. In Step-2 study DS has been validated in 74new cases of SFM. Patients with AI have been replaced withInj. hydrocortisone and compared with the patients withouthydrocortisone of Step-1 study.Results: Out of 142 cases of SFM, 50 (35.2%) patients had AIas defined by cortisol level <10ug/dl. DS of >0.35 could ableto discriminate AI with sensitivity, specificity, and predictivevalue of 92.5%, 91.6%, and 85.7% respectively. The mostcommon presentations are hypotension, hypoglycemia, andhyponatremia. After replacement of steroid the mortality waslow (7.4%) compared to without replacement (18.0%).Conclusion: The present study showed that AI is common inSFM and replacement of hydrocortisone is necessary in thosepatients for reduction of mortality. DS can be used to predictAI and patients with score >0.35 may be administered withlow dose steroid.