Autoantibody levels are associated with acute kidney injury, anemia and post-discharge morbidity and mortality in Ugandan children with severe malaria

Sci Rep. 2019 Oct 17;9(1):14940. doi: 10.1038/s41598-019-51426-z.

Abstract

Autoantibodies targeting host antigens contribute to autoimmune disorders, frequently occur during and after infections and have been proposed to contribute to malaria-induced anemia. We measured anti-phosphatidylserine (PS) and anti-DNA antibody levels in 382 Ugandan children prospectively recruited in a study of severe malaria (SM). High antibody levels were defined as antibody levels greater than the mean plus 3 standard deviations of community children (CC). We observed increases in median levels of anti-PS and anti-DNA antibodies in children with SM compared to CC (p < 0.0001 for both). Children with severe malarial anemia were more likely to have high anti-PS antibodies than children with cerebral malaria (16.4% vs. 7.4%), p = 0.02. Increases in anti-PS and anti-DNA antibodies were associated with decreased hemoglobin (p < 0.05). A one-unit increase in anti-DNA antibodies was associated with a 2.99 (95% CI, 1.68, 5.31) increase odds of acute kidney injury (AKI) (p < 0.0001). Elevated anti-PS and anti-DNA antibodies were associated with post-discharge mortality (p = 0.031 and p = 0.042, respectively). Children with high anti-PS antibodies were more likely to have multiple hospital readmissions compared to children with normal anti-PS antibody levels (p < 0.05). SM is associated with increased autoantibodies against PS and DNA. Autoantibodies were associated with anemia, AKI, post-discharge mortality, and hospital readmission.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Acute Kidney Injury / blood
  • Acute Kidney Injury / epidemiology*
  • Acute Kidney Injury / immunology
  • Anemia / blood
  • Anemia / epidemiology*
  • Anemia / immunology
  • Autoantibodies / blood*
  • Autoantibodies / immunology
  • Autoantigens / immunology*
  • Child
  • Child, Preschool
  • DNA / immunology
  • Female
  • Follow-Up Studies
  • Humans
  • Infant
  • Malaria, Falciparum / complications*
  • Malaria, Falciparum / immunology
  • Malaria, Falciparum / mortality
  • Male
  • Patient Discharge
  • Patient Readmission / statistics & numerical data
  • Phosphatidylserines / immunology
  • Plasmodium falciparum / immunology
  • Prospective Studies
  • Risk Assessment / methods
  • Risk Assessment / statistics & numerical data
  • Severity of Illness Index
  • Uganda / epidemiology

Substances

  • Autoantibodies
  • Autoantigens
  • Phosphatidylserines
  • DNA