Table 2 Strict research definition of severe malaria [2]

Impaired consciousness: A Glasgow Coma Score < 11 in adults or a Blantyre Coma Score < 3 in children

Acidosis: A base deficit of > 8 meq/L or, if unavailable, a plasma bicarbonate of < 15 mmol/L or venous plasma lactate > 5 mmol/L. Severe acidosis manifests clinically as respiratory distress – rapid, deep and laboured breathing

Hypoglycaemia: Blood or plasma glucose < 2.2 mmol/L (< 40 mg/dl)

Severe malarial anaemia: A haemoglobin concentration < 5 g/dL or a haematocrit of < 15% in children < 12 years of age (< 7 g/dL and < 20%, respectively, in adults) together with a parasite count > 10,000/µL

Renal impairment (acute kidney injury): Plasma or serum creatinine > 265 µmol/L (3 mg/dL) or blood urea > 20 mmol/L

Jaundice: Plasma or serum bilirubin > 50 µmol/L (3 mg/dL) together with a parasite count > 100,000/µL

Pulmonary oedema: Radiologically confirmed, or oxygen saturation < 92% on room air with a respiratory rate > 30/min, often with chest indrawing and crepitations on auscultation

Significant bleeding: Including recurrent or prolonged bleeding from nose gums or venepuncture sites; haematemesis or melaena

Shock: Compensated shock is defined as capillary refill ≥ 3 s or temperature gradient on the leg (mid to proximal limb), but no hypotension. Decompensated shock is defined as a systolic blood pressure < 70 mm Hg in children or < 80 mm Hg in adults with evidence of impaired perfusion (cool peripheries or prolonged capillary refill)

Hyperparasitaemia: P. falciparum parasitaemia > 10%