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Balerdi-Sarasola L, Parolo C, Fleitas P, Cruz A, Subirà C, Rodríguez-Valero N, Almuedo-Riera A, Letona L, Álvarez-Martínez MJ, Valls ME, Vera I, Mayor A, Muñoz J, Camprubí-Ferrer D. Host biomarkers for early identification of severe imported Plasmodium falciparum malaria. Travel Med Infect Dis 2023; 54:102608. [PMID: 37348666 DOI: 10.1016/j.tmaid.2023.102608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 05/30/2023] [Accepted: 06/13/2023] [Indexed: 06/24/2023]
Abstract
BACKGROUND Severe imported P. falciparum malaria is a source of morbi-mortality in non-endemic regions. WHO criteria don't accurately classify patients at risk of complications. There is a need to evaluate new tools such as biomarkers to better identify patients with severe imported malaria. METHODS A case-control study was conducted in Barcelona, from January 2011-January 2021. Adult patients with microbiologically confirmed P. falciparum malaria were classified according to WHO criteria. Patients with imported non-malarial fevers were included as controls. In each group, angiopoietin-1 (Ang-1), angiopoietin-2 (Ang-2), soluble triggering receptor expressed on myeloid cells (sTREM-1), C-reactive protein (CRP) and platelets were measured and their concentrations were compared between groups. New groups were made with a modified WHO severity classification and biomarkers' performance was evaluated using multiple imputation models. RESULTS 131 participants were included: 52 severe malaria, 30 uncomplicated malaria and 49 non-malarial fever cases. All biomarkers except sTREM-1 showed significant differences between groups. Using the modified WHO severity classification, Ang-2 and CRP presented the best AUROC; 0.79 (95%CI 0.64-0.94) and 0.80(95%CI 0.67-0.93). A model combining CRP and Ang-2 showed the best AUROC, of 0.84(95%CI 0.68-0.99), with the highest sensitivity and specificity: 84.6%(95%CI 58.9-98.1) and 77.4% (95%CI 65.9-87.7), respectively. CONCLUSIONS The combination of Ang-2 and CRP may be a reliable tool for the early identification of severe imported malaria. The use of a rapid prognostic test including the mentioned biomarkers could optimize imported malaria management, with the potential to decrease the rate of complications and hospitalizations in patients with imported malaria.
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Affiliation(s)
| | - C Parolo
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - P Fleitas
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - A Cruz
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - C Subirà
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | | | - A Almuedo-Riera
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - L Letona
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - M J Álvarez-Martínez
- Microbiology Department, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain
| | - M Eugenia Valls
- Microbiology Department, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain
| | - I Vera
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - A Mayor
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain; Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - J Muñoz
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain; CIBERINFEC, ISCIII - CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, Madrid, Spain
| | - D Camprubí-Ferrer
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
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