Aspartate aminotransferase-to-platelet ratio index (APRI): A potential marker for diagnosis in patients at risk of severe malaria caused by Plasmodium vivax

Abstract

Acute infection with Plasmodium vivax, classically associated with benign disease, has been presenting as serious and even fatal disease in recent years. Severe disease is mainly due to biochemical and hematological alterations during the acute phase of infection. In the present cross-sectional study, the aspartate aminotransferase-to-platelet ratio index (APRI) was evaluated as a method for identifying patients at risk of severe vivax malaria. This retrospective study included 130 patients with confirmed P. vivax infection between June 2006 and January 2018. Clinical-epidemiological data were obtained from medical records. Hematological and biochemical parameters were determined using automated equipment. The criteria of severity for infection by Plasmodium falciparum, established by the World Health Organization (WHO), were adapted to classify patients with danger signs of severe vivax malaria. Of the 130 patient’s records evaluated, 19 (14.6%) had one or more signs and symptoms of severe malaria. The mean APRI values among patients with and without severe malaria were 2.11 and 1.09, respectively (p = 0.044). Among those with severe disease, the proportion with an APRI value above 1.50 was 30% compared to the 10% among those without severe disease (p = 0.007). The area under the receiver operating characteristic curve (95% CI), calculated to assess the accuracy of the APRI in discriminating between patients with and without severe disease, was 0.645 (0.494; 0.795). An APRI cutoff of 0.74 resulted in sensitivity of 74.0%, specificity of 56.0%, and accuracy of 65.0%. This study shows that the APRI is elevated in patients with evidence of infection by P. vivax. Based on the good sensitivity found in this study, we conclude that this simple index can serve as a diagnostic biomarker to identify patients at risk of severe disease during the acute phase of P. vivax infection.

Alteration of Platelet Count in Patients with Severe Non-Plasmodium falciparum Malaria: A Systematic Review and Meta-Analysis

“…Additional searches of reference lists and other sources identified nine articles meeting the inclusion criteria. A total of 33 studies were included in this systematic review and assessed for methodological quality [ 10 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 ].…”

“…Thirty-three studies from Asia (India [ 10 , 23 , 25 , 31 , 35 , 36 , 37 , 38 , 39 , 40 , 43 , 46 , 47 , 49 , 50 , 51 ], Malaysia [ 29 , 30 , 53 , 54 ], Indonesia [ 32 ], Papua New Guinea [ 42 ], and Republic of Korea [ 45 ]) and South America (Brazil [ 24 , 33 , 34 , 41 , 48 , 52 ] and Colombia [ 26 , 27 , 28 , 44 ]) reported data on 1495 individuals with severe non- P . falciparum malaria.…”

“…vivax and P. knowlesi malaria. Of the included studies, 30 [ 10 , 23 , 24 , 25 , 26 , 27 , 28 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 ] reported outcomes of 1371 cases of severe P . vivax single infections, while four [ 29 , 30 , 53 , 54 ] reported outcomes of 124 cases with severe P .…”

Hematological indices and abnormalities among patients with uncomplicated falciparum malaria in Kosti city of the White Nile state, Sudan: a comparative study

“…Hematological abnormalities can contribute to the pathogenesis and complications of the disease [ 3 ]. Therefore, the profile of hematological indices can help physicians to predict malaria consequences and to improve malaria case management in different epidemiological situations [ 6 , 7 ]. Malaria is a leading cause of anemia worldwide and contributes to approximately 25.0% of anemia prevalence in sub-Saharan Africa [ 8 ].…”

Hematological Indices and Abnormalities Among Patients With Uncomplicated Falciparum Malaria in Kosti City of the White Nile State, Sudan: a Comparative Study

“…Hematological abnormalities can contribute to the pathogenesis and complications of the disease [3] and differ according to disease endemicity, nutritional and immune status, co-existence of hemoglobinopathies and demographic factors [6][7][8][9][10][11][12][13][14][15]. Therefore, the pro le of hematological indices can help physicians to predict malaria consequences and to improve malaria case management in different epidemiological situations [12][13][14][15]. Malaria is a leading cause of anemia worldwide and contributes to approximately 25.0% of anemia prevalence in sub-Saharan Africa [16].…”