Medical Technology Program, Faculty of Science, Nakhon Phanom University, Nakhon Phanom, 48000, Thailand.
Department of Medical Technology, Faculty of Pharmacy, University of Santo Tomas, 1008, Manila, Philippines.
Sci Rep. 2024 Aug 6;14(1):18162. doi: 10.1038/s41598-024-68596-0.
Malaria has complex interactions with host physiology, including alterations in cortisol levels. Cortisol, a key hormone in the stress response, is known to be dysregulated in various infectious diseases. This systematic review and meta-analysis aimed to elucidate the relationship between Plasmodium infection and cortisol levels, shedding light on the intricate interplay between the parasite and the host's endocrine system. The methodological protocol for assessing cortisol levels in malaria patients was registered in PROSPERO (CRD42024496578), a widely recognized international prospective register of systematic reviews. This registration ensures transparency and minimizes the risk of bias in our research. A comprehensive search strategy was employed across major databases, including Embase, PubMed, Scopus, and Medline, to include studies that reported cortisol levels in infected patients. The qualitative synthesis was undertaken to synthesize the difference in cortisol levels between malaria-infected and uninfected individuals. The meta-analysis employed the random effects model in the quantitative synthesis to calculate the effect estimate. The review included a total of 20 studies, with a substantial number conducted in Africa, followed by Asia and South America. Most included studies (13/20, 65%) reported higher cortisol levels in infected patients than in uninfected patients. The meta-analysis confirmed significantly higher cortisol levels in infected patients compared to uninfected individuals (P < 0.0001, standardized mean difference (SMD): 1.354, 95% confidence interval: 0.913 to 1.795, I: 88.3%, across 15 studies). Notably, the method for cortisol measurement and the type of blood sample used (serum or plasma) were significant moderators in the analysis, indicating that these factors may influence the observed relationship between Plasmodium infection and cortisol levels. The systematic review and meta-analysis confirmed that Plasmodium infection is associated with increased cortisol levels, highlighting the intricate relationship between the disease and the host stress response. These findings underscore the potential of cortisol as a supplementary biomarker for understanding the pathophysiological impact of malaria. By providing insights into the stress-related mechanisms of malaria, this comprehensive understanding can inform future research and potentially enhance disease management and treatment strategies, particularly in regions heavily burdened by malaria.
疟疾与宿主生理学之间存在复杂的相互作用，包括皮质醇水平的改变。皮质醇是应激反应中的关键激素，已知在各种传染病中失调。本系统评价和荟萃分析旨在阐明疟原虫感染与皮质醇水平之间的关系，揭示寄生虫与宿主内分泌系统之间的复杂相互作用。评估疟疾患者皮质醇水平的方法学方案已在 PROSPERO（CRD42024496578）中注册，PROSPERO 是一个广泛认可的国际系统评价前瞻性注册库，可确保研究的透明度并最大程度地降低偏倚风险。采用全面的搜索策略在主要数据库（包括 Embase、PubMed、Scopus 和 Medline）中进行搜索，以纳入报告感染患者皮质醇水平的研究。定性综合用于综合感染患者与未感染患者之间皮质醇水平的差异。荟萃分析采用随机效应模型进行定量综合，以计算效应估计值。该综述共纳入 20 项研究，其中大部分（20/20，100%）在非洲进行，其次是亚洲和南美洲。大多数纳入的研究（13/20，65%）报告感染患者的皮质醇水平高于未感染患者。荟萃分析证实感染患者的皮质醇水平明显高于未感染个体（P<0.0001，标准化均数差（SMD）：1.354，95%置信区间：0.913 至 1.795，I²：88.3%，纳入 15 项研究）。值得注意的是，皮质醇测量方法和所用血液样本类型（血清或血浆）是分析中的显著调节因素，表明这些因素可能影响观察到的疟原虫感染与皮质醇水平之间的关系。系统评价和荟萃分析证实，疟原虫感染与皮质醇水平升高有关，突出了疾病与宿主应激反应之间的复杂关系。这些发现强调了皮质醇作为理解疟疾病理生理影响的补充生物标志物的潜力。通过深入了解疟疾相关的应激机制，可以为未来的研究提供信息，并有可能增强疾病管理和治疗策略，特别是在疟疾负担沉重的地区。
