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Intensive Care Med ; 42(10): 1588-1596, 2016 Oct.
Article in English | MEDLINE | ID: mdl-27169586

ABSTRACT

PURPOSE: Prospective data on potential factors associated with severity of imported Plasmodium falciparum malaria are lacking. We evaluated whether several host- and parasite-related biomarkers may improve early severity evaluation. METHODS: Prospective multicenter observational study comparing uncomplicated and severe imported falciparum malaria in adults conducted in France in 52 units, from 2007 to 2010. Association of several host- and parasite-related biomarkers with severity of malaria was tested using univariate and multivariate analyses. RESULTS: Of 295 patients, 140 had uncomplicated malaria and 155 severe malaria (including very severe and less severe cases according to predefined criteria). Curative intravenous quinine treatment was used in 154/155 patients with severe malaria and atovaquone/proguanil in 74 % of patients with uncomplicated malaria. Hospital mortality was 5.2 % (8 patients), all in the severe malaria group. Among host-related biomarkers, CRP, procalcitonin, and sTREM-1 were significantly higher and albumin was significantly lower in severe versus uncomplicated malaria; only the last three biomarkers also differed significantly between the very and less severe malaria groups. Among parasite-related biomarkers, only plasma PfHRP2 was significantly higher in severe versus uncomplicated malaria and in very severe versus less severe malaria; parasitemia did not differ between very and less severe malaria. By multivariate analysis, only lower plasma albumin and higher sTREM-1 were associated with greater severity, with intermediate accuracies. CONCLUSIONS: During imported malaria, the most useful biomarkers associated with severity seem to be plasma albumin and sTREM-1; and among parasite-related parameters, PfHRP2 was more strongly associated with severity than parasitemia was.


Subject(s)
Antigens, Protozoan/blood , Antimalarials/therapeutic use , Malaria, Falciparum/blood , Malaria, Falciparum/drug therapy , Plasmodium falciparum , Protozoan Proteins/blood , Quinine/therapeutic use , Severity of Illness Index , Adult , Analysis of Variance , Animals , Atovaquone/therapeutic use , Biomarkers/blood , C-Reactive Protein/analysis , Calcitonin/blood , Drug Combinations , Female , France , Host-Parasite Interactions , Humans , Malaria, Falciparum/parasitology , Male , Middle Aged , Parasitemia/blood , Proguanil/therapeutic use , Prospective Studies
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