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Table 1 Criteria of severe malaria according to the 2014 World Health Organization definition with minor modifications

From: Hypertension is associated with an increased risk for severe imported falciparum malaria: a tertiary care hospital based observational study from Berlin, Germany

CriterionSpecification
Impaired consciousnessGlasgow coma scale (GCS) < 11
Multiple convulsions> 2 convulsions within 24 h
Respiratory distress or acidotic breathingRequirement of non-invasive or endotracheal mechanical ventilation or respiratory rate ≥ 40 breaths/min on room air
Circulatory collapse or shockSystolic blood pressure < 80 mm Hg or ≤ 80 mm Hg despite volume repletion
Acute pulmonary oedemaConfirmed radiologically
Acute respiratory distress syndrome (ARDS)Lung injury of acute onset, within 1 week of an apparent clinical insult and with progression of respiratory symptoms; bilateral opacities on chest imaging not explained by other lung pathology (e.g. pleural effusion, pneumothorax, or nodules); respiratory failure not explained by heart failure or volume overload; decreased arterial PaO2/FiO2 ratio (≤ 300 mmHg)
Renal impairmentPlasma or serum creatinine > 3 mg/dl (> 265 µmol/l)
Metabolic acidosispH < 7.25 or plasma bicarbonate < 15 mmol/l or lactate > 5 mmol/l or ≥ 45 mg/dl
JaundiceBilirubin > 50 µmol/l or > 3 mg/dl together with circulatory instability, respiratory distress, impaired consciousness, severe coagulopathy, or acute kidney injury
Malaria-induced anaemiaHaemoglobin level < 70 g/l or haematocrit < 20% not related to other causes than malaria
Abnormal bleedingIncluding recurrent or prolonged bleeding from the nose, gums, venepuncture sites, hematemesis or melaena
Macroscopic haemoglobinuriaMacroscopic haemoglobinuria related to malaria
HypoglycaemiaBlood glucose level < 40 mg/dl (< 2.2 µmol/l)
Hyperparasitaemia> 5% parasitized erythrocytes