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

  • Sachin Vemula Kasturba Medical College, Manipal University, Mangalore, India
  • Vidyalakshmi Katara Kasturba Medical College, Manipal University, Mangalore, India
  • Unnikrishnan Bhaskaran Kasturba Medical College, Manipal University, Mangalore, India
  • Sushma Adappa Kasturba Medical College, Manipal University, Mangalore, India
  • Mahabala Chakrapani Kasturba Medical College, Manipal University, Mangalore, India
Keywords: Severe malaria, C-reactive protein, acute-phase reactant, inflammatory marker, erythrocyte sedimentation rate

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.

Author Biographies

Sachin Vemula, Kasturba Medical College, Manipal University, Mangalore, India
Department of Medicine
Vidyalakshmi Katara, Kasturba Medical College, Manipal University, Mangalore, India
Professor,Department of Microbiology
Unnikrishnan Bhaskaran, Kasturba Medical College, Manipal University, Mangalore, India
Professor,Department of Community Medicine
Sushma Adappa, Kasturba Medical College, Manipal University, Mangalore, India
Research Assistant,Department of Medicine
Mahabala Chakrapani, Kasturba Medical College, Manipal University, Mangalore, India
Professor,Department of Medicine
Published
2016-12-30
How to Cite
1.
Vemula S, Katara V, Bhaskaran U, Adappa S, Chakrapani M (2016) Pretreatment elevated erythrocyte sedimentation rate and C-reactive protein as a predictor of malarial complications. J Infect Dev Ctries 10:1332-1337. doi: 10.3855/jidc.8053
Section
Original Articles