Dhangadamajhi Gunanidhi, Panigrahi Subhendu, Roy Shaktirekha, Tripathy Sagnika
Department of Biotechnology, North Orissa University, Baripada, Odisha, India.
Department of Medicine, Veer Surendra Sai Institute of Medical Sciences and Research, Sambalpur, Odisha, India; Department of Gastroenterology, SCB Medical College and Hospital, Cuttack, Odisha, India.
Acta Trop. 2019 Feb;190:1-8. doi: 10.1016/j.actatropica.2018.10.007. Epub 2018 Oct 19.
The extent of abnormalities in blood indices and their subsequent effects on clinical severity in malaria differ among populations of different endemicity. However, these alterations have not been well investigated in Odisha, India and their prognostic implications in the context of multi-organ dysfunction (MODS) in severe malaria (SM) are not identified so far. The present study was carried out in 200 adult patients each from uncomplicated malaria and severe malaria groups to examine whether host haematological and biochemical parameters in Plasmodium falciparum infection can act as diagnostic marker for SM in adults patients of Odisha. The results showed thrombocytopenia as a potential risk factor for SM irrespective of disease features with least median platelet counts observed in patients with MODS (Platelet count: 144.5, P = < 0.0001) compared to mild malaria. Logistic regression analysis identified anemia (<10 mg/dl) as independent predictor of MODS (OR = 12.78, 95% CI = 4.93-33.2). The prognostic utility of thrombocytopenia (platelet count: ≤100,000/μl) as marker of MODS was largely modulated by hemoglobin and blood glucose level. Co-existence of hypoglycemia and thrombocytopenia was also observed. Our study revealed changes in blood indices such as low platelet, hemoglobin and blood glucose during falciparum infection in adults can be used as diagnostic criteria for predicting SM in combinations. The study also provides important clue for plausible hypoglycemia mediated platelet necrosis and clearance. Further studies in different endemic regions need to be conducted for validation of these findings and their implication as criteria for diagnosing SM in adults.
不同疟疾流行程度的人群中，血液指标异常的程度及其对疟疾临床严重程度的后续影响有所不同。然而，印度奥里萨邦尚未对这些变化进行充分研究，而且到目前为止，尚未明确它们在重症疟疾（SM）多器官功能障碍（MODS）背景下的预后意义。本研究对200名分别来自非重症疟疾组和重症疟疾组的成年患者进行，以检验恶性疟原虫感染时宿主的血液学和生化参数是否可作为奥里萨邦成年患者重症疟疾的诊断标志物。结果显示，无论疾病特征如何，血小板减少都是重症疟疾的一个潜在危险因素，与轻度疟疾相比，多器官功能障碍患者的血小板计数中位数最低（血小板计数：144.5，P = < 0.0001）。逻辑回归分析确定贫血（<10mg/dl）是多器官功能障碍的独立预测因素（OR = 12.78，95% CI = 4.93 - 33.2）。血小板减少（血小板计数：≤100,000/μl）作为多器官功能障碍标志物的预后效用在很大程度上受血红蛋白和血糖水平的调节。还观察到低血糖和血小板减少并存的情况。我们的研究表明，成人恶性疟原虫感染期间血小板、血红蛋白和血糖等血液指标的变化可联合用作预测重症疟疾的诊断标准。该研究还为低血糖介导的血小板坏死和清除提供了重要线索。需要在不同流行地区进行进一步研究，以验证这些发现及其作为成人重症疟疾诊断标准的意义。
