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Published on: July 17, 2014
Prognostic value of circulating pigmented cells in African children with malaria
Peter Gottfried Kremsner1, Clarissa Valim, Michel A Missinou
1Medical Research Unit, Albert Schweitzer Hospital, Lambaréné, Gabon.
Insights
Malarial pigment in blood cells is not a reliable predictor of mortality in African children with Plasmodium falciparum malaria. Large-scale studies show low predictive ability, despite some site-specific associations with fatal outcomes.
Area of Science:
- Malariology
- Pediatric Infectious Diseases
- Clinical Epidemiology
Background:
- Plasmodium falciparum malaria is a significant cause of illness in African children.
- Predicting mortality risk in these children remains challenging.
- Previous research suggested malarial pigment as a potential severity marker, but lacked sufficient sample size.
Purpose of the Study:
- To evaluate the prognostic value of pigment-containing cells (granulocytes, monocytes) and parasites in predicting mortality.
- To assess the utility of circulating malarial pigment as a biomarker for severe malaria outcomes in children.
Main Methods:
- Analysis of thick blood smears from 26,296 hospitalized children with P. falciparum malaria.
- Assessment of pigment-containing granulocytes, monocytes, and parasites at admission.
- Logistic regression models incorporating established severe malaria markers were used to estimate adjusted odds ratios.
Main Results:
- A higher risk of mortality was observed with >5 pigmented granulocytes per 200 white blood cells at most sites.
- However, adjusted analyses indicated moderate to nonexistent associations between pigmented cells and mortality across most sites.
- The predictive capability of pigmented cells was low, as indicated by the receiver operating characteristic curve analysis.
Conclusions:
- While elevated levels of pigmented cells showed some association with fatal outcomes at specific study locations, they are not universally useful predictors.
- Circulating malarial pigment is not a reliable prognostic biomarker for mortality across diverse African settings in children with severe malaria.
Background:
Plasmodium falciparum malaria is a common cause of morbidity in African children, but identifying those who are likely to die is problematic. Previous studies suggested that circulating malarial pigment might be a useful predictor of severity, but none were large enough to detect any association with mortality.
Methods:
We used thick blood smears performed on admission for 26,296 children hospitalized with P. falciparum at 1 of 6 hospitals in the Severe Malaria in African Children network to assess the prognostic value of pigment-containing granulocytes, monocytes, and parasites.
Results:
Although at all but one of the study sites the risk of mortality for subjects presenting with >5 pigmented granulocytes per 200 white blood cells was higher than in subjects with no pigmented granulocytes, adjusted odds ratios estimated through logistic regression, which included other established markers of severe malaria, suggested that associations between pigmented cells and mortality were moderate to nonexistent in most sites. The predictive ability of pigmented cells was low, as measured by the change in the area under the receiver operating characteristic curve of logistic regression models.
Conclusions:
Although high levels of pigmented cells were associated with a fatal outcome in some study sites, they were not useful predictors of outcome across Africa.
