Balerdi-Sarasola L, Parolo C, Fleitas P, Cruz A, Subirà C, Rodríguez-Valero N, Almuedo-Riera A, Letona L, Álvarez-Martínez M J, Valls M Eugenia, Vera I, Mayor A, Muñoz J, Camprubí-Ferrer D
ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain.
ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain.
Travel Med Infect Dis. 2023 Jul-Aug;54:102608. doi: 10.1016/j.tmaid.2023.102608. Epub 2023 Jun 20.
Severe imported P. falciparum malaria is a source of morbi-mortality in non-endemic regions. WHO criteria don't accurately classify patients at risk of complications. There is a need to evaluate new tools such as biomarkers to better identify patients with severe imported malaria.
A case-control study was conducted in Barcelona, from January 2011-January 2021. Adult patients with microbiologically confirmed P. falciparum malaria were classified according to WHO criteria. Patients with imported non-malarial fevers were included as controls. In each group, angiopoietin-1 (Ang-1), angiopoietin-2 (Ang-2), soluble triggering receptor expressed on myeloid cells (sTREM-1), C-reactive protein (CRP) and platelets were measured and their concentrations were compared between groups. New groups were made with a modified WHO severity classification and biomarkers' performance was evaluated using multiple imputation models.
131 participants were included: 52 severe malaria, 30 uncomplicated malaria and 49 non-malarial fever cases. All biomarkers except sTREM-1 showed significant differences between groups. Using the modified WHO severity classification, Ang-2 and CRP presented the best AUROC; 0.79 (95%CI 0.64-0.94) and 0.80(95%CI 0.67-0.93). A model combining CRP and Ang-2 showed the best AUROC, of 0.84(95%CI 0.68-0.99), with the highest sensitivity and specificity: 84.6%(95%CI 58.9-98.1) and 77.4% (95%CI 65.9-87.7), respectively.
The combination of Ang-2 and CRP may be a reliable tool for the early identification of severe imported malaria. The use of a rapid prognostic test including the mentioned biomarkers could optimize imported malaria management, with the potential to decrease the rate of complications and hospitalizations in patients with imported malaria.
严重输入性恶性疟原虫疟疾是非流行地区发病和死亡的一个来源。世界卫生组织（WHO）的标准不能准确地对有并发症风险的患者进行分类。有必要评估诸如生物标志物等新工具，以更好地识别严重输入性疟疾患者。
2011年1月至2021年1月在巴塞罗那进行了一项病例对照研究。微生物学确诊的恶性疟原虫疟疾成年患者根据WHO标准进行分类。纳入输入性非疟疾发热患者作为对照。在每组中，测量血管生成素-1（Ang-1）、血管生成素-2（Ang-2）、髓样细胞上表达的可溶性触发受体（sTREM-1）、C反应蛋白（CRP）和血小板，并比较两组之间的浓度。采用改良的WHO严重程度分类创建新的组，并使用多重插补模型评估生物标志物的性能。
共纳入131名参与者：52例严重疟疾、30例非复杂性疟疾和49例非疟疾发热病例。除sTREM-1外，所有生物标志物在组间均显示出显著差异。使用改良的WHO严重程度分类，Ang-2和CRP的曲线下面积（AUROC）最佳；分别为0.79（95%置信区间0.64 - 0.94）和0.80（95%置信区间0.67 - 0.93）。结合CRP和Ang-2的模型显示出最佳的AUROC，为0.
