Pretreatment elevated erythrocyte sedimentation rate and C-reactive protein as a predictor of malarial complications

Abstract

Introduction: Complications of malaria can develop suddenly and unexpectedly. Although various parameters have been associated with severity of malaria, they have not been studied as predictors of these events. Many of the malarial complications are inflammatory in nature, and C-reactive protein (CRP) and elevated erythrocyte sedimentation rate (ESR) could be early markers of these complications and might precede and predict the development of complications. Methodology: A total of 122 inpatients with uncomplicated newly diagnosed malaria were studied. CRP, ESR, hemoglobin, and platelets were measured before initiating treatment. Patients were monitored closely for the subsequent development of complications based on the World Health Organization's definition of severe malaria. Results: Seven patients (5.7%) had worsening of symptoms compared to the day of admission and had higher pretreatment CRP and increased ESR compared to those patients who did not develop complications. Area under receiver operator characteristic curve was 0.761(p=0.02) for CRP and 0.739 (p = 0.035) for ESR. CRP>124 mg/L and increased ESR (>34.5 mm in the first hour) had a sensitivity of 71.4% and specificity of 79.1%, respectively, for predicting complications of malaria. Other parameters did not reach statistical significance for predicting complications. Elevated CRP and elevated ESR had a negative predictive value of 97.8%. Conclusions: Elevated CRP>124mg/L and increased ESR>34.5 mm in the first hour at the time of diagnosis in patients with uncomplicated malaria identifies patients who might subsequently develop complications of malaria.

The Association between CRP Levels with Comorbidities, Species, and Complications of Severe Malaria

“…Considerably, our study illustrated that the levels of CRP were significantly greater in patients with complicationsthan those without complications (P< 0.05). Consistently, several studies (6,9,36) mentioned that patients with complications had significantly elevated CRP levels compared to those without complication (P< 0.05). Although, found CRP levels at presentation showed positive correlation with duration of hospital stay (r = 0.59; P < 0.05) (6), we showed that CRP levels were not significantly correlated with length of hospital stay .…”

Polymorphism in the pvcrt-o and pvmdr-1 genes of Plasmodium vivax associated with a better prognosis for malaria

“…In the studies by Lima- Junior et al (2012), Alves-Junior et al (2020), and Paul et al (2012), higher CRP levels were found in the plasma of individuals infected with P. vivax, suggesting a more robust inflammatory profile for infection by P. vivax, and can be used as a marker of prognosis, severity and follow-up (Lima- Junior et al, 2012;Paul et al, 2012;Vemula et al, 2016, Alves-Junior et al, 2020.…”

“…Currently, the laboratory parameter C-reactive protein (CRP) is the best marker for classification of the severity of malaria caused by P. vivax, as it demonstrates an inflammatory state from the disease that may be more or less intense (Paul et al, 2012;Vemula et al, 2016). Even in a recent study, as described by Alves-Junior (2020), among 42 parameters, CRP was the most sensitive to demonstrate the worst or best prognosis of a patient with vivax malaria.…”

“…There was also an association between the C393T polymorphism of pvcrt-o with serum concentrations of CRP. That is, patients with vivax malaria infected with parasites carrying this polymorphism had lower concentrations of CRP at the time of diagnosis, which would be indicative of a better prognosis (Alves- Junior et al, 2020;Lima-Junior et al, 2012;Paul et al, 2012;Vemula et al, 2016).…”