Bilirubin Cut-off Level to Predict Fatal Outcome of Severe Falciparum Malaria with Jaundice

Abstract

Background: Although jaundice is WHO (2010) criteria for severe malaria. However total bilirubin level in the severe malaria patients with jaundice was not mentioned. The objective of this study was to find the cut-off point of total bilirubin level sensitive to detect fatal outcome in severe malaria patients with jaundice. Methods: 174 severe falciparum malaria patients were included into the study. Clinical and laboratory data of the survived severe malaria patients and fatal severe malaria patients were compared. Receiver Operative Curve (ROC) was constructed to evaluate sensitivity of total bilirubin to detect fatal jaundiced patients. Results: There were 29 fatal patients (17%). Out of 117 jaundiced patients, 27 patients were fatal (23%). ROC showed low bilirubin as 2 mg/dl was early observed in 97% fatal severe malaria patients with jaundice. Conclusion: Cut-off of bilirubin level in jaundiced severe malaria patients should be ≥ 2 mg/dl which could detect fatal outcome with sensitivity of 97%