Procalcitonin is elevated in severe malaria and is a promising biomarker of severe malaria and multi-organ dysfunction: A cross-sectional study and meta-analysis

Rina Tripathy; Bidyut K Das; Aditya K Panda

doi:10.1016/j.intimp.2023.110923

Procalcitonin is elevated in severe malaria and is a promising biomarker of severe malaria and multi-organ dysfunction: A cross-sectional study and meta-analysis

Int Immunopharmacol. 2023 Nov;124(Pt A):110923. doi: 10.1016/j.intimp.2023.110923. Epub 2023 Sep 14.

Authors

Rina Tripathy¹, Bidyut K Das², Aditya K Panda³

Affiliations

¹ Department of Biochemistry, Sardar Vallabhbhai Patel Post Graduate Institute of Pediatrics, Cuttack, Odisha 753002, India. Electronic address: rinatripathy@hotmail.com.
² Department of Clinical Immunology and Rheumatology, SCB Medical College, Cuttack, Odisha 753007, India. Electronic address: bidyutdas@hotmail.com.
³ Department of Biotechnology, Berhampur University, Bhanja Bihar, Berhampur, Odisha 760007, India; Centre of Excellence on "Bioprospecting of Ethnopharmaceuticals of Southern Odisha" (CoE-BESO), Berhampur University, Bhanja Bihar, Berhampur, Odisha 760007, India. Electronic address: akp.bt@buodisha.edu.in.

PMID: 37716164
DOI: 10.1016/j.intimp.2023.110923

Abstract

Background: Elevated procalcitonin (PCT) has been reported in bacterial infection and is positively associated with the severity of the disease. Patients with severe Plasmodium falciparum malaria also display higher procalcitonin levels compared to those with non-severe disease, indicating a possible role for bacterial infection in severe disease, however this observation remained variable in different study population. Furthermore, the significance of PCT in different clinical categories of severe malaria has not been evaluated so far.

Methods: A total of 74 P. falciparum-infected subjects were enrolled in the study comprising of 55 cases complicated malaria [cerebral malaria- 14; non-cerebral severe malaria- 21; multi-organ dysfunction- 20] and 19 uncomplicated cases. Serum levels of PCT were quantified by fluorescence immunoassay. For meta-analysis, the literature search was performed in different databases, and all relevant articles were screened, and eligible reports were identified based on predefined inclusion and exclusion criteria. The meta-analysis was performed by comprehensive meta-analysis software V3 and MedCalc 20.218.

Results: Patients with severe P. falciparum malaria had significantly higher PCT levels compared to uncomplicated cases (p = 0.01). Analysis of PCT in different categories of patients with severe malaria revealed significantly elevated PCT in multi-organ dysfunctions compared to those with uncomplicated malaria (p = 0.004) and cerebral malaria (p = 0.05). Interestingly the receiver operating characteristics curve analysis showed procalcitonin as a promising biomarker for differentiating severe malaria (AUC: 0.697, p = 0.01) and multi-organ dysfunction (AUC: 0.704, p = 0.007) from uncomplicated malaria and other clinical categories of falciparum malaria, respectively. Furthermore, meta-analysis also revealed an elevated procalcitonin in severe malaria and it could be an important biomarker in the management of severe disease.

Conclusions: PCT is elevated in P. falciparum-infected patients and could be a good biomarker for diagnosis of severe malaria and multi-organ dysfunction. It can help in the management of severe disease with additional treatment options.

Keywords: Multi-organ dysfunction; Plasmodium falciparum; Procalcitonin; Uncomplicated malaria.