Objective:

This systematic review aims to identify and evaluate the factors associated with the prognosis in individuals with cerebral malaria.

Background:

Despite advancements in treatment, cerebral malaria remains a significant cause of mortality. This warrants identification of indicators to predict clinical outcome in these individuals.

Design/Methods:

A comprehensive search was conducted across the various electronic databases (PubMed, Embase, Scopus, Cochrane library, CINHAL and clinical trials registries) to identify the relevant studies. The analysis was performed using RevMan, version 5.4.1.

Results:

A total of eight studies with 5654 participants were included in the quantitative synthesis. The respiratory rate (MD 5.47, 95% CI [4.77, 6.17], n=6304, I²=0%), parasite density (MD 0.35, 95% CI [0.11, 0.59], n=5420, I²=0%), white blood cell count (MD 5.68, 95% CI [1.84, 9.52], n=1259, I²=67%), serum lactate (MD 2.66, 95% CI [0.68, 4.65], n=988, I²=0%), serum creatinine (MD 33.57, 95% CI [11.28, 55.86], n=999, I²=0%), total bilirubin (MD 0.83, 95% CI [0.38, 1.27], n=212, I²=0% were greater in mortality group as compared to the survivor group. The parasitemia (OR 1.01, 95% CI [0.92, 1.10]), respiratory rate (OR 1.03, 95% CI [0.99, 1.07]), white blood cell count (OR 1.04, 95% CI [0.98, 1.09]), serum lactate (OR 1.08, 95% CI [0.93, 1.27]) and pulse rate (OR 1.01, 95% CI [0.99, 1.02]) were not statistically significant. However, patients with respiratory distress had higher odds of mortality (OR 10.44, 95% CI [4.45, 24.48], n=233, I²=0%).

Conclusions:

In cerebral malaria, respiratory rate, white blood cell count, and serum creatinine significantly increased in non-survivors compared to survivors, indicating potential prognostic value. Notably, respiratory distress emerged as a strong predictor of mortality in these cases.