Duangchan Thitinat, Kotepui Manas, Sukati Suriyan, Rattanapan Yanisa, Wangdi Kinley
Medical Technology, School of Allied Health Sciences, Walailak University, Tha Sala, Nakhon Si Thammarat 80160, Thailand.
Hematology and Transfusion Science Research Center, Walailak University, Tha Sala, Nakhon Si Thammarat 80160, Thailand.
Trop Med Infect Dis. 2023 May 23;8(6):289. doi: 10.3390/tropicalmed8060289.
Disseminated intravascular coagulation (DIC) is a potentially life-threatening condition that causes systemic coagulation to be turned on and coagulation factors to be used up. However, the evidence for DIC in malaria patients is still not clear, and small case series and retrospective studies have shown varying results. This meta-analysis was intended for the evaluation of the evidence of DIC among malaria patients using a meta-analysis approach. The protocol for the systematic review was registered at PROSPERO as CRD42023392194. Studies that investigated DIC in patients with malaria were searched in Ovid, Scopus, Embase, PubMed, and MEDLINE. The pooled proportion with 95% confidence intervals (CI) of DIC among malaria patients was estimated using a random-effects model. A total of 1837 articles were identified, and 38 articles were included in the meta-analysis. The overall proportion of DIC in malaria was 11.6% (95% CI: 8.9%-14.3%, I: 93.2%, 38 studies). DIC in severe malaria and fatal malaria was 14.6% (95% CI: 5.0-24.3%, I: 95.5%, 11 studies) and 82.2% (95% CI: 56.2-100%, I: 87.3, 4 studies). The estimates of DIC among severe malaria patients who had multi-organ dysfunction with bleeding, cerebral malaria, acute renal failure, and ≥2 complications were 79.6% (95% CI: 67.1-88.2%, one study), 11.9% (95% CI: 7.9-17.6%, one study), 16.7% (95% CI: 10.2-23.3%, ten studies), and 4.8% (95% CI: 1.9-7.7%, nine studies), respectively. The proportion estimates of DIC among the patients with malaria depended on the species, clinical severity, and types of severe complications. The information from this study provided useful information to guide the management of malaria patients. Future studies are needed to investigate the association between infection and DIC and to understand the mechanism of malaria-induced DIC.
弥散性血管内凝血（DIC）是一种潜在的危及生命的病症，可导致全身凝血启动并使凝血因子耗尽。然而，疟疾患者中DIC的证据仍不明确，小型病例系列研究和回顾性研究显示出不同的结果。本荟萃分析旨在采用荟萃分析方法评估疟疾患者中DIC的证据。该系统评价的方案已在PROSPERO注册，注册号为CRD42023392194。在Ovid、Scopus、Embase、PubMed和MEDLINE中检索了调查疟疾患者DIC的研究。使用随机效应模型估计疟疾患者中DIC的合并比例及95%置信区间（CI）。共识别出1837篇文章，38篇文章纳入荟萃分析。疟疾中DIC的总体比例为11.6%（95%CI：8.9%-14.3%，I²：93.2%，38项研究）。重症疟疾和致命性疟疾中DIC的比例分别为14.6%（95%CI：5.0-24.3%，I²：95.5%，11项研究）和82.2%（95%CI：56.2-100%，I²：87.3%，4项研究）。在伴有出血的多器官功能障碍、脑型疟疾、急性肾衰竭及≥2种并发症的重症疟疾患者中，DIC的估计比例分别为79.6%（95%CI：67.1-88.2%，1项研究）、11.9%（95%CI：7.9-17.6%，1项研究）、16.7%（95%CI：10.2-23.3%，10项研究）和4.8%（95%CI：1.9-7.7%，9项研究）。疟疾患者中DIC的比例估计取决于疟原虫种类、临床严重程度和严重并发症类型。本研究所得信息为指导疟疾患者的管理提供了有用信息。未来需要开展研究以调查感染与DIC之间的关联，并了解疟疾诱发DIC的机制。
