Factors Associated with Prolonged Hospital Length of Stay in Adults with Imported Falciparum Malaria—An Observational Study from a Tertiary Care University Hospital in Berlin, Germany

Abstract

Outcome of falciparum malaria is largely influenced by the standard of care provided, which in turn depends on the available medical resources. Worldwide, the COVID-19 pandemic has had a major impact on the availability of these resources, even in resource-rich healthcare systems such as Germany’s. The present study aimed to determine the under-explored factors associated with hospital length of stay (LOS) in imported falciparum malaria to identify potential targets for improving management. This retrospective observational study used multivariate Cox proportional hazard regression with time to discharge as an endpoint for adults hospitalized between 2001 and 2015 with imported falciparum malaria in the Charité University Hospital, Berlin. The median LOS of the 535 cases enrolled was 3 days (inter-quartile range, IQR, 3–4 days). The likelihood of being discharged by day 3 strongly decreased with severe malaria (hazard ratio, HR, 0.274; 95% Confidence interval, 95%CI: 0.190–0.396) and by 40% with each additional presenting complication (HR, 0.595; 95%CI: 0.510–0.694). The 55 (10.3%) severe cases required a median LOS of 7 days (IQR, 5–12 days). In multivariate analysis, occurrence of shock (adjusted HR, aHR, 0.438; 95%CI 0.220–0.873), acute pulmonary oedema or acute respiratory distress syndrome (aHR, 0.450; 95%CI: 0.223–0.874), and the need for renal replacement therapy (aHR, 0.170; 95%CI: 0.063–0.461) were independently associated with LOS. All patients survived to discharge. This study illustrates that favourable outcomes can be achieved with high-standard care in imported falciparum malaria. Early recognition of disease severity together with targeted supportive care can lead to avoidance of manifest organ failure, thereby potentially decreasing LOS and alleviating pressure on bed capacities.

Factors associated with hospital length of stay in patients admitted with suspected malaria in Kenya: secondary analysis of a cross-sectional survey

“…We found LOS significantly shorter than the 7 days reported under trial conditions in South East Asia 13 and slightly longer than the 3 days LOS reported in a retrospective observational study from a tertiary hospital setting in Germany. 14 The reported LOS differences between studies likely reflect the severity specifics of the studied malaria populations ranging from exclusively focused severe malaria patients in Southeast Asia 13 over a quarter of severe malaria cases estimated in our study to only 10% of severe cases included in the malaria sample in Germany. 14 …”

“… 14 The reported LOS differences between studies likely reflect the severity specifics of the studied malaria populations ranging from exclusively focused severe malaria patients in Southeast Asia 13 over a quarter of severe malaria cases estimated in our study to only 10% of severe cases included in the malaria sample in Germany. 14 …”

“… 13 Another observational study investigated malaria LOS predictors in a high-resource tertiary hospital in Germany. 14 Studies based in routine clinical settings from low resource but high malaria risk areas in Africa have not been undertaken. In this study, the factors associated with hospital LOS for patients admitted with suspected malaria in the presence of competing risk events were examined in routine clinical settings in Kenya.…”

Remdesivir, COVID-19, and Clinical Outcomes

“…Also, discharge criteria might be varied, depending on bed requirement situation. During COVID-19 outbreak, stress on bed availability occurs and might affect standard of care 2 . Length of hospital stay not only for COVID-19 but also for other infectious disease might have to be shortened 2 .…”

“…During COVID-19 outbreak, stress on bed availability occurs and might affect standard of care 2 . Length of hospital stay not only for COVID-19 but also for other infectious disease might have to be shortened 2 . Therefore, data on length of stay might be easily biased.…”