1
|
Segbefia SP, Asandem DA, Amoah LE, Kusi KA. Cytokine gene polymorphisms implicated in the pathogenesis of Plasmodium falciparum infection outcome. Front Immunol 2024; 15:1285411. [PMID: 38404582 PMCID: PMC10884311 DOI: 10.3389/fimmu.2024.1285411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 01/24/2024] [Indexed: 02/27/2024] Open
Abstract
Cytokines play a critical role in the immune mechanisms involved in fighting infections including malaria. Polymorphisms in cytokine genes may affect immune responses during an infection with Plasmodium parasites and immunization outcomes during routine administration of malaria vaccines. These polymorphisms can increase or reduce susceptibility to this deadly infection, and this may affect the physiologically needed balance between anti-inflammatory and pro-inflammatory cytokines. The purpose of this review is to present an overview of the effect of selected cytokine gene polymorphisms on immune responses against malaria.
Collapse
Affiliation(s)
- Selorm Philip Segbefia
- Department of Immunology, Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, Accra, Ghana
- Department of Molecular Medicine, School of Medicine and Dentistry, College of Science, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana
| | - Diana Asema Asandem
- Department of Virology, Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, Accra, Ghana
- West African Centre for Cell Biology of Infectious Pathogens, Department of Biochemistry, Cell and Molecular Biology, College of Basic and Applied Sciences, University of Ghana, Accra, Ghana
| | - Linda Eva Amoah
- Department of Immunology, Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, Accra, Ghana
- West African Centre for Cell Biology of Infectious Pathogens, Department of Biochemistry, Cell and Molecular Biology, College of Basic and Applied Sciences, University of Ghana, Accra, Ghana
| | - Kwadwo Asamoah Kusi
- Department of Immunology, Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, Accra, Ghana
- West African Centre for Cell Biology of Infectious Pathogens, Department of Biochemistry, Cell and Molecular Biology, College of Basic and Applied Sciences, University of Ghana, Accra, Ghana
| |
Collapse
|
2
|
Transforming Growth Factor-β Concerning Malarial Infection and Severity: A Systematic Review and Meta-Analysis. Trop Med Infect Dis 2022; 7:tropicalmed7100299. [PMID: 36288040 PMCID: PMC9612234 DOI: 10.3390/tropicalmed7100299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 10/07/2022] [Accepted: 10/08/2022] [Indexed: 11/17/2022] Open
Abstract
Transforming growth factor-β (TGF-β) is important in the pathophysiology of malaria, but its role in acute and severe malaria is largely unknown. As a result, this study used a meta-analysis approach to investigate the difference in TGF-β levels between several groups of malaria patients and healthy controls. The systematic review protocol was registered at PROSPERO (ID: CRD42022318864). From inception to 7 March 2022, studies that reported TGF-β levels in patients with uncomplicated and healthy controls and patients with severe and uncomplicated malaria were searched in PubMed, Scopus and Embase. The assessment of the quality of the included studies was conducted according to the Strengthening the Reporting of Observational Studies in Epidemiology guidelines. Qualitative and quantitative syntheses were performed to narratively describe and quantitatively pool the mean difference (MD) in TGF-β levels between uncomplicated malaria and healthy controls, and between severe and uncomplicated malaria, using a random-effects model. A total of 1027 relevant articles were identified, and 13 studies were included for syntheses. The meta-analysis results show 233 patients with uncomplicated malaria and 239 healthy controls. Patients with uncomplicated malaria (233 cases) had lower mean TGF-β levels than healthy controls (239 cases; p < 0.01, pooled MD = −14.72 pg/mL, 95% confidence interval (95% CI) = −20.46 to 8.99 pg/mL, I2 = 98.82%, seven studies). The meta-analysis found no difference in mean TGF-β levels between patients with severe malaria (367 cases) and patients with uncomplicated malaria (180 cases; p = 0.11, pooled MD = −6.07 pg/mL, 95% CI = −13.48 to 1.35 pg/mL, I2 = 97.73%, six studies). The meta-analysis demonstrated decreased TGF-β levels in patients with uncomplicated malaria compared to healthy controls. In addition, no difference in TGF-β levels was found between patients with severe and uncomplicated malaria. More research is needed to determine whether TGF-β levels could be a candidate marker for malarial infection or disease severity.
Collapse
|
3
|
Datta D, Bangirana P, Opoka RO, Conroy AL, Co K, Bond C, Zhao Y, Kawata K, Saykin AJ, John CC. Association of Plasma Tau With Mortality and Long-term Neurocognitive Impairment in Survivors of Pediatric Cerebral Malaria and Severe Malarial Anemia. JAMA Netw Open 2021; 4:e2138515. [PMID: 34889945 PMCID: PMC8665370 DOI: 10.1001/jamanetworkopen.2021.38515] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
IMPORTANCE Cerebral malaria (CM) and severe malarial anemia (SMA) are associated with persistent neurocognitive impairment (NCI) among children in Africa. Identifying blood biomarkers of acute brain injury that are associated with future NCI could allow early interventions to prevent or reduce NCI in survivors of severe malaria. OBJECTIVE To investigate whether acutely elevated tau levels are associated with future NCI in children after CM or SMA. DESIGN, SETTING, AND PARTICIPANTS This prospective cohort study was conducted at Mulago National Referral Hospital in Kampala, Uganda, from March 2008 to October 2015. Children aged 1.5 to 12 years with CM (n = 182) or SMA (n = 162) as well as community children (CC; n = 123) were enrolled in the study. Data analysis was conducted from January 2020 to May 2021. EXPOSURE CM or SMA. MAIN OUTCOMES AND MEASURES Enrollment plasma tau levels were measured using single-molecule array detection technology. Overall cognition (primary) and attention and memory (secondary) z scores were measured at 1 week and 6, 12, and 24 months after discharge using tools validated in Ugandan children younger than 5 years or 5 years and older. RESULTS A total of 467 children were enrolled. In the CM group, 75 (41%) were girls, and the mean (SD) age was 4.02 (1.92) years. In the SMA group, 59 (36%) were girls, and the mean (SD) age was 3.45 (1.60) years. In the CC group, 65 (53%) were girls, and the mean (SD) age was 3.94 (1.92) years. Elevated plasma tau levels (>95th percentile in CC group; >6.43 pg/mL) were observed in 100 children (55%) with CM and 69 children (43%) with SMA (P < .001). In children with CM who were younger than 5 years, elevated plasma tau levels were associated with increased mortality (odds ratio [OR], 3.06; 95% CI, 1.01-9.26; P = .048). In children with CM who were younger than 5 years at both CM episode and follow-up neurocognitive testing, plasma tau levels (log10 transformed) were associated with worse overall cognition scores over 24-month follow-up (β = -0.80; 95% CI, -1.32 to -0.27; P = .003). In children with CM who were younger than 5 years at CM episode and 5 years or older at follow-up neurocognitive testing, plasma tau was associated with worse scores in attention (β = -1.08; 95% CI, -1.79 to -0.38; P = .003) and working memory (β = -1.39; 95% CI, -2.18 to -0.60; P = .001). CONCLUSIONS AND RELEVANCE In this study, plasma tau, a marker of injury to neuronal axons, was elevated in children with CM or SMA and was associated with mortality and persistent NCI in children with CM younger than 5 years.
Collapse
Affiliation(s)
- Dibyadyuti Datta
- Ryan White Center for Pediatric Infectious Disease and Global Health, Indiana University School of Medicine, Indianapolis
| | - Paul Bangirana
- Department of Psychiatry, Makerere University College of Health Sciences, Kampala, Uganda
| | - Robert O Opoka
- Department of Paediatrics and Child Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Andrea L Conroy
- Ryan White Center for Pediatric Infectious Disease and Global Health, Indiana University School of Medicine, Indianapolis
| | - Katrina Co
- Ryan White Center for Pediatric Infectious Disease and Global Health, Indiana University School of Medicine, Indianapolis
| | - Caitlin Bond
- Ryan White Center for Pediatric Infectious Disease and Global Health, Indiana University School of Medicine, Indianapolis
| | - Yi Zhao
- Department of Biostatistics and Health Sciences, Indiana University School of Medicine, Indianapolis
| | - Keisuke Kawata
- Department of Kinesiology, Indiana University School of Public Health-Bloomington, Bloomington
- Program in Neuroscience, The College of Arts and Sciences, Indiana University, Bloomington
| | - Andrew J Saykin
- Indiana Alzheimer's Disease Research Center and Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis
| | - Chandy C John
- Ryan White Center for Pediatric Infectious Disease and Global Health, Indiana University School of Medicine, Indianapolis
- Division of Global Pediatrics, University of Minnesota Medical School, Minneapolis
| |
Collapse
|
4
|
Recent Advances in Understanding the Inflammatory Response in Malaria: A Review of the Dual Role of Cytokines. J Immunol Res 2021; 2021:7785180. [PMID: 34790829 PMCID: PMC8592744 DOI: 10.1155/2021/7785180] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 10/01/2021] [Accepted: 10/15/2021] [Indexed: 11/25/2022] Open
Abstract
Malaria is a serious and, in some unfortunate cases, fatal disease caused by a parasite of the Plasmodium genus. It predominantly occurs in tropical areas where it is transmitted through the bite of an infected Anopheles mosquito. The pathogenesis of malaria is complex and incompletely elucidated. During blood-stage infection, in response to the presence of the parasite, the host's immune system produces proinflammatory cytokines including IL-6, IL-8, IFN-γ, and TNF, cytokines which play a pivotal role in controlling the growth of the parasite and its elimination. Regulatory cytokines such as transforming growth factor- (TGF-) β and IL-10 maintain the balance between the proinflammatory and anti-inflammatory responses. However, in many cases, cytokines have a double role. On the one hand, they contribute to parasitic clearance, and on the other, they are responsible for pathological changes encountered in malaria. Cytokine-modulating strategies may represent a promising modern approach in disease management. In this review, we discuss the host immune response in malaria, analyzing the latest studies on the roles of pro- and anti-inflammatory cytokines.
Collapse
|
5
|
Abstract
Transforming Growth Factor-β is a potent regulator of the immune system, acting at every stage from thymic differentiation, population of the periphery, control of responsiveness, tissue repair and generation of memory. It is therefore a central player in the immune response to infectious pathogens, but its contribution is often clouded by multiple roles acting on different cells in time and space. Hence, context is all-important in understanding when TGF-β is beneficial or detrimental to the outcome of infection. In this review, a full range of infectious agents from viruses to helminth parasites are explored within this framework, drawing contrasts and general conclusions about the importance of TGF-β in these diseases.
Collapse
Affiliation(s)
- Rick M Maizels
- Wellcome Centre for Integrative Parasitology, Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, United Kingdom.
| |
Collapse
|
6
|
Andoh NE, Gyan BA. The Potential Roles of Glial Cells in the Neuropathogenesis of Cerebral Malaria. Front Cell Infect Microbiol 2021; 11:741370. [PMID: 34692564 PMCID: PMC8529055 DOI: 10.3389/fcimb.2021.741370] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 09/17/2021] [Indexed: 01/02/2023] Open
Abstract
Cerebral malaria (CM) is a severe neurological complication of malaria caused by the Plasmodium falciparum parasite. It is one of the leading causes of death in children under 5 years of age in Sub-Saharan Africa. CM is associated with blood-brain barrier disruption and long-term neurological sequelae in survivors of CM. Despite the vast amount of research on cerebral malaria, the cause of neurological sequelae observed in CM patients is poorly understood. In this article, the potential roles of glial cells, astrocytes, and microglia, in cerebral malaria pathogenesis are reviewed. The possible mechanisms by which glial cells contribute to neurological damage in CM patients are also examined.
Collapse
Affiliation(s)
- Nana Efua Andoh
- Noguchi Memorial Institute for Medical Research, Department of Parasitology, University of Ghana, Accra, Ghana
| | - Ben Adu Gyan
- Noguchi Memorial Institute for Medical Research, Department of Immunology, University of Ghana, Accra, Ghana
| |
Collapse
|
7
|
Immunosuppression in Malaria: Do Plasmodium falciparum Parasites Hijack the Host? Pathogens 2021; 10:pathogens10101277. [PMID: 34684226 PMCID: PMC8536967 DOI: 10.3390/pathogens10101277] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 09/27/2021] [Accepted: 09/28/2021] [Indexed: 12/13/2022] Open
Abstract
Malaria reflects not only a state of immune activation, but also a state of general immune defect or immunosuppression, of complex etiology that can last longer than the actual episode. Inhabitants of malaria-endemic regions with lifelong exposure to the parasite show an exhausted or immune regulatory profile compared to non- or minimally exposed subjects. Several studies and experiments to identify and characterize the cause of this malaria-related immunosuppression have shown that malaria suppresses humoral and cellular responses to both homologous (Plasmodium) and heterologous antigens (e.g., vaccines). However, neither the underlying mechanisms nor the relative involvement of different types of immune cells in immunosuppression during malaria is well understood. Moreover, the implication of the parasite during the different stages of the modulation of immunity has not been addressed in detail. There is growing evidence of a role of immune regulators and cellular components in malaria that may lead to immunosuppression that needs further research. In this review, we summarize the current evidence on how malaria parasites may directly and indirectly induce immunosuppression and investigate the potential role of specific cell types, effector molecules and other immunoregulatory factors.
Collapse
|
8
|
Sirisabhabhorn K, Chaijaroenkul W, Na-Bangchang K. Genetic Diversity of Human Host Genes Involved in Immune Response and the Binding of Malaria Parasite in Patients Residing along the Thai-Myanmar border. Trop Med Infect Dis 2021; 6:tropicalmed6040174. [PMID: 34698295 PMCID: PMC8544681 DOI: 10.3390/tropicalmed6040174] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 09/22/2021] [Accepted: 09/22/2021] [Indexed: 12/05/2022] Open
Abstract
Polymorphisms of the genes encoding proteins involved in immune functions and the binding of malaria parasites to human host cells have been the focus of research in recent years, aiming to understand malaria pathogenesis and case severity and to exploit this knowledge to assert control over malaria. This study investigated the genetic diversity of the human host genes encoding proteins that are involved in immune functions and malaria parasite binding, i.e., MCP1 (−2518), TGFβ1 (−509), TNFα (−308), IL4 (VNTR), IL6 (−174), IL10 (−3575), TLR4 (299), CD36 (−188), and ICAM1 (469) in patients with mono-infection of Plasmodium falciparum and Plasmodium vivax infections in the multidrug-resistant areas along the Thai-Myanmar border. The association between gene polymorphisms and parasite density was also investigated. Genomic DNA (gDNA) of P. falciparum and P. vivax were extracted from whole blood and dried blood spot (DBS). Gene amplification and genotyping were performed by PCR and PCR-RFLP analysis, respectively. Of these samples, 178 and 209 samples were, respectively, mono-infection with P. falciparum and P. vivax. The ratio of P. falciparum: P. vivax was 46%:54%. Results showed marked variation in the frequency distribution and patterns of the genotypes and gene alleles of the nine immune response genes or human host genes. The SNPs of TGFβ1, IL10 and ICAM1, were significantly associated with P. falciparum, but not P. vivax parasite density. TGFβ1, IL10 and ICAM1, may play more significant roles in modulating P. falciparum than P. vivax parasitemia. The prevalence of the genotypes and gene alleles of these genes, including their association with parasite density, may vary depending on patient ethnicity and endemic areas. Information obtained from each endemic area is essential for treatment strategies and the development of vaccines for malaria prophylaxis in specific areas.
Collapse
Affiliation(s)
- Kridsada Sirisabhabhorn
- Graduate Program in Bioclinical Sciences, Chulabhorn International College of Medicine, Thammasat University (Rangsit Campus), Pathumthani 12121, Thailand; (K.S.); (W.C.)
| | - Wanna Chaijaroenkul
- Graduate Program in Bioclinical Sciences, Chulabhorn International College of Medicine, Thammasat University (Rangsit Campus), Pathumthani 12121, Thailand; (K.S.); (W.C.)
- Center of Excellence in Pharmacology and Molecular Biology of Malaria and Cholangiocarcinoma, Thammasat University (Rangsit Campus), Pathumthani 12121, Thailand
| | - Kesara Na-Bangchang
- Graduate Program in Bioclinical Sciences, Chulabhorn International College of Medicine, Thammasat University (Rangsit Campus), Pathumthani 12121, Thailand; (K.S.); (W.C.)
- Center of Excellence in Pharmacology and Molecular Biology of Malaria and Cholangiocarcinoma, Thammasat University (Rangsit Campus), Pathumthani 12121, Thailand
- Drug Discovery and Development Center, Office of Advanced Science and Technology, Thammasat University (Rangsit Campus), Pathumthani 12121, Thailand
- Correspondence: or ; Tel.: +662-564-4440-79 (ext. 1803); Fax: +662-564-4398
| |
Collapse
|
9
|
Drewry LL, Harty JT. Balancing in a black box: Potential immunomodulatory roles for TGF-β signaling during blood-stage malaria. Virulence 2021; 11:159-169. [PMID: 32043415 PMCID: PMC7051139 DOI: 10.1080/21505594.2020.1726569] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Malarial disease caused by Plasmodium parasites challenges the mammalian immune system with a delicate balancing act. Robust inflammatory responses are required to control parasite replication within red blood cells, which if unchecked, can lead to severe anemia and fatality. However, the same inflammatory response that controls parasite replication is also associated with immunopathology and severe disease, as is exemplified by cerebral malaria. A robust literature has identified critical roles for innate, cellular, and humoral immune responses orchestrated by IFN-γ and TH1 type responses in controlling blood stage malarial disease. In contrast, TGF-β and IL-10 have been identified as important anti–inflammatory immunomodulators that help to limit inflammation and pathology during malaria. TGF-β is a pleiotropic cytokine, with the ability to exert a wide variety of context-dependent immunomodulatory roles. The specific mechanisms that allow TGF-β to protect against malarial pathology remain essentially unexplored and offer a promising avenue to dissect the most critical elements of immunomodulation in avoiding severe malaria. Here we discuss potential immunomodulatory roles for TGF-β during malaria in light of recent advances in our understanding of the role of Tregs during blood-stage malaria.
Collapse
Affiliation(s)
- Lisa L Drewry
- Department of Microbiology and Immunology, University of Iowa, Iowa City, IA, USA
| | - John T Harty
- Department of Microbiology and Immunology, University of Iowa, Iowa City, IA, USA.,Department of Pathology, University of Iowa, Iowa City, IA, USA.,Interdisciplinary Graduate Program in Immunology, University of Iowa, Iowa City, IA, USA
| |
Collapse
|
10
|
de Jong GM, McCall MBB, Dik WA, Urbanus RT, Wammes LJ, Koelewijn R, Sauerwein RW, Verbon A, van Hellemond JJ, van Genderen PJJ. Transforming growth factor-beta profiles correlate with clinical symptoms and parameters of haemostasis and inflammation in a controlled human malaria infection. Cytokine 2019; 125:154838. [PMID: 31525609 DOI: 10.1016/j.cyto.2019.154838] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 08/09/2019] [Accepted: 09/04/2019] [Indexed: 12/23/2022]
Abstract
BACKGROUND After a controlled human malaria infection (CHMI), presentation of clinical signs and symptoms and host responses is heterogeneous. Transforming growth factor-beta (TGF-β) is the first serum cytokine that changes in malaria-naïve volunteers after CHMI. We studied a possible relation between TGF-β changes, pro-inflammatory cytokines, activation of haemostasis and endothelial cells and clinical symptoms. METHODS A panel of cytokines including TGF-β, and markers of activation of haemostasis and endothelial cells were measured in blood samples of 15 volunteers at baseline before CHMI and during CHMI at day of treatment. The change of the parameters on the day of treatment was examined for a significant alteration during infection. RESULTS Nine of 15 volunteers showed a significant decrease in TGF-β compared to baseline, with concomitant increased concentrations of D-dimer (p = 0.012), Von Willebrand factor (p = 0.017), IL-6 (p = 0.012) and IFN-γ (0.028) and a significantly decreased platelet count (p = 0.011). In contrast, 6 of 15 volunteers showed sustained or increased TGF-β concentrations without change in the aforementioned parameters. The sustained responders presented with less moderate and severe clinical symptoms than the negative responders (p = 0.036) and had a higher baseline lymphocyte count (p = 0.026). TGF-β concentrations did not correlate with the parasitaemia on day of treatment. CONCLUSION Early decreases of serum TGF-β might function a marker for a pro-inflammatory host response and downstream clinical symptoms and pathology during CHMI.
Collapse
Affiliation(s)
- Gerdie M de Jong
- Department of Medical Microbiology & Infectious Diseases, Erasmus MC University Medical Center, Rotterdam 3015 GD, the Netherlands
| | - Matthew B B McCall
- Department of Medical Microbiology & Infectious Diseases, Erasmus MC University Medical Center, Rotterdam 3015 GD, the Netherlands; Department of Medical Microbiology, Radboud University Medical Center, Nijmegen 6500HB, the Netherlands
| | - Willem A Dik
- Department of Immunology, Laboratory Medical Immunology, Erasmus MC University Medical Center, Rotterdam 3015GD, the Netherlands
| | - Rolf T Urbanus
- Department of Clinical Chemistry and Haematology, 3584 CX, University Medical Center, Utrecht, the Netherlands
| | - Linda J Wammes
- Department of Medical Microbiology & Infectious Diseases, Erasmus MC University Medical Center, Rotterdam 3015 GD, the Netherlands
| | - Rob Koelewijn
- Department of Medical Microbiology & Infectious Diseases, Erasmus MC University Medical Center, Rotterdam 3015 GD, the Netherlands
| | - Robert W Sauerwein
- Department of Medical Microbiology, Radboud University Medical Center, Nijmegen 6500HB, the Netherlands
| | - Annelies Verbon
- Department of Medical Microbiology & Infectious Diseases, Erasmus MC University Medical Center, Rotterdam 3015 GD, the Netherlands
| | - Jaap J van Hellemond
- Department of Medical Microbiology & Infectious Diseases, Erasmus MC University Medical Center, Rotterdam 3015 GD, the Netherlands
| | - Perry J J van Genderen
- Department of Medical Microbiology & Infectious Diseases, Erasmus MC University Medical Center, Rotterdam 3015 GD, the Netherlands.
| |
Collapse
|
11
|
Chao CT, Tsai HB, Chiang CK, Huang JW. Thrombocytopenia on the first day of emergency department visit predicts higher risk of acute kidney injury among elderly patients. Scand J Trauma Resusc Emerg Med 2017; 25:11. [PMID: 28187736 PMCID: PMC5303206 DOI: 10.1186/s13049-017-0355-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2016] [Accepted: 01/30/2017] [Indexed: 12/31/2022] Open
Abstract
Background Few studies have addressed risk factors for acute kidney injury (AKI) in geriatric patients. We investigated whether thrombocytopenia was a risk factor for AKI in geriatric patients with medical illnesses. Methods A prospective cohort study was conducted, by recruiting elderly (≥65 years) patients who visited the emergency department (ED) for medical illnesses during 2014. They all received hemogram for platelet count determination, and were stratified according to the presence of thrombocytopenia (platelets, <150 K/μL) during their initial ED evaluation. They were prospectively followed up during their ED stay. We analyzed the relationship between the diagnosis of thrombocytopenia and subsequent AKI after ED stay, using Cox proportional hazard modeling, with platelet count as a continuous variable or thrombocytopenia as a categorical variable. Results Of 136 elderly patients (mean age of 80.7 ± 8.2 years, 40% with chronic kidney disease, and 39% with diabetes) enrolled, 22.8% presented with thrombocytopenia, without differences in baseline renal function. After a mean ED stay of 4.4 ± 2.1 days, 41.9% developed AKI (52.6% Kidney Disease Improving Global Outcomes [KDIGO] grade 1, 24.6% grade 2, and 22.8% grade 3). Patients with higher AKI severity had stepwise lower platelet counts compared to those without AKI. The Cox proportional hazard model revealed that lower platelet count as a continuous variable (hazard ratio [HR] 0.984, 95% confidence interval [CI] 0.975–0.994) and as a categorical variable (presence of thrombocytopenia) (HR 1.86, 95% CI 1.06–3.27) increased the risk of AKI. The sensitivity analyses accounting for nephrotoxic medications use, including non-steroidal anti-inflammatory drugs, vancomycin, and contrast, yielded similar results. Discussion Thrombocytopenia is common among ED-visiting elderly, and the potential relationship between platelet counts and the risk of AKI suggests the utility of checking hemogram for those at-risk ofdeveloping adverse renal events. Conclusion Thrombocytopenia on initial presentation might indicate an increased risk of AKI among elderly patients with medical illnesses.
Collapse
Affiliation(s)
- Chia-Ter Chao
- Department of Medicine, National Taiwan University Hospital Jinshan Branch, New Taipei City, Taiwan.,Graduate Institute of Toxicology, National Taiwan University College of Medicine, Taipei, Taiwan.,Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital, 7 Chung-Shan South Road, Taipei, 100, Taiwan
| | - Hung-Bin Tsai
- Department of Traumatology, National Taiwan University Hospital, Taipei, Taiwan
| | - Chih-Kang Chiang
- Graduate Institute of Toxicology, National Taiwan University College of Medicine, Taipei, Taiwan.,Department of Integrative Diagnostics and Therapeutics, National Taiwan University Hospital, Taipei, Taiwan
| | - Jenq-Wen Huang
- Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital, 7 Chung-Shan South Road, Taipei, 100, Taiwan.
| | | |
Collapse
|