Study of C reactive protein as a prognostic marker in malaria from Eastern India

Abstract

Background:C-reactive protein (CRP) is useful as marker of severity in malaria. African studies have shown that serum CRP levels correlate with parasite burden and complications in malaria, especially falciparum. However, there are very few data on CRP levels in Indian malaria patients.Materials and Methods:We assessed CRP levels in malaria patients at presentation and studied for any relation of CRP levels with subsequent prognosis. Statistical tests included student's t-test, Mann Whitney U test, and chi square test, all with 2-tailed analyzes.Results:Of 71 patients in our study, 42 (59.1%) were infected with P. falciparum. 23 (32.4%) patients needed admission and 10 (14.1%) died. Average CRP levels were quite high in malaria patients (31.29 ± 20.4 mg/L). There was no significant difference in CRP between vivax and falciparum cases. Admitted patients had significantly higher CRP levels compared to those treated on outdoor basis (47.11 ± 19.13 vs. 23.71 ± 16.35 mg/L; P < 0.0001). 8 patients were admitted with multiple complications. They had significantly high CRP level compared to those with 1 complication (P = 0.015). Also, patients who died had higher CRP levels compared to survivors (P = 0.000346). CRP levels at presentation showed positive correlation with duration of hospital stay (r = 0.59; P < 0.05). CRP levels >35 mg/L was highly sensitive in predicting mortality.Conclusion:Our study in Indian population corroborates the findings in African studies regarding prognostic role of CRP in malaria. CRP is an effective biomarker in assessing malaria severity and also for follow-up.

Prognostic value of Serum C-Reactive Protein in Malaria

“…Also patients who were admitted had higher CRP levels than patients who were treated on OPD basis. Similar findings were observed by Paul et al 8 & Bainik Adhikari 11 in their study. In our study, we measured CRP levels only at the time of admission or first contact, However serial measurement of CRP levels, can be even better at assessment of course of the disease.…”

“…Thus, measurement of CRP can be useful in understanding the pathogenesis of severe malaria. 8 The results of the study showed that CRP levels are increased significantly in patients with malarial infection. Also CRP levels were significantly higher in patients with Plasmodium falciparum infection compared to patients with Plasmodium vivax infection.…”

“…Also CRP levels were significantly higher in patients with Plasmodium falciparum infection compared to patients with Plasmodium vivax infection. Paul et al 8 in their study found that CRP Levels are increased significantly in Malaria infected patients but found no significant difference between P. falciparum and P. vivax cases. However our results are in accordance with Agrawal et al 7 who found mean CRP to be higher in the plasma of P. Falciparum infected patients compared to P. vivax infected patients.…”

“…Thus, measures to identify severity of this disease are needed so as to institute timely therapy and avoid the complications. 8 CRP is an acute phase reactant and is one of the most widely used acute phase inflammatory proteins because of its early rise and rapid kinetics. It binds damaged host cells including erythrocytes infected by P. falciparum resulting in their clearance by both humoral and cellular immune mechanisms.…”

“…Thus, measurement of CRP can be useful in understanding the pathogenesis of severe malaria. 8 However, studies involving measurement of CRP in malaria patients are quite few in India, this study was designed to evaluate whether measurements of CRP in malaria patients can be used to assess disease severity and can be used as prognostic marker in Malaria.…”