Advanced Biomedical Research

Study of C reactive protein as a prognostic marker in malaria from Eastern India

Authors

Department of Medicine, Medical College Kolkata, Kolkata, India

Abstract

Background: C-reactive protein (CRP) is useful as marker of severity in malaria. African studies have shown that serum CRP levels correlate with parasite burden and complications in malaria, especially falciparum. However, there are very few data on CRP levels in Indian malaria patients.
Materials and Methods: We assessed CRP levels in malaria patients at presentation and studied for any relation of CRP levels with subsequent prognosis. Statistical tests included student's t-test, Mann Whitney U test, and chi square test, all with 2-tailed analyzes.
Results: Of 71 patients in our study, 42 (59.1%) were infected with P. falciparum. 23 (32.4%) patients needed admission and 10 (14.1%) died. Average CRP levels were quite high in malaria patients (31.29 ± 20.4 mg/L). There was no significant difference in CRP between vivax and falciparum cases. Admitted patients had significantly higher CRP levels compared to those treated on outdoor basis (47.11 ± 19.13 vs. 23.71 ± 16.35 mg/L; P < 0.0001). 8 patients were admitted with multiple complications. They had significantly high CRP level compared to those with 1 complication (P = 0.015). Also, patients who died had higher CRP levels compared to survivors (P = 0.000346). CRP levels at presentation showed positive correlation with duration of hospital stay (r = 0.59; P < 0.05). CRP levels >35 mg/L was highly sensitive in predicting mortality.
Conclusion: Our study in Indian population corroborates the findings in African studies regarding prognostic role of CRP in malaria. CRP is an effective biomarker in assessing malaria severity and also for follow-up.

Keywords

1. Rowe AK, Rowe SY, Snow RW, Korenromp EL, Schellenberg JR, Stein C, et al. The burden of malaria mortality among African children in the year 2000. Int J Epidemiol 2006;35:691-704.  Back to cited text no. 1
[PUBMED]    
2. Erdman LK, Dhabangi A, Musoke C, Conroy AL, Hawkes M, Higgins S, et al. Combinations of host biomarkers predict mortality among Ugandan children with severe malaria: A retrospective case-control study. PLoS One 2011; 6:e17440.  Back to cited text no. 2
[PUBMED]    
3. Conroy AL, Lafferty EI, Lovegrove FE, Krudsood S, Tangpukdee N, Liles WC, et al. Whole blood angiopoietin-1 and -2 levels discriminate cerebral and severe (non-cerebral) malaria from uncomplicated malaria. Malar J. 2009; 8:295.  Back to cited text no. 3
[PUBMED]    
4. Hurt N, Smith T, Tanner M, Mwankusye S, Bordmann G, Weiss NA, et al. Evaluation of C-reactive protein and haptoglobin as malaria episode markers in an area of high transmission in Africa. Trans R Soc Trop Med Hyg 1994;88:182-6.  Back to cited text no. 4
[PUBMED]    
5. McGuire W, D'Alessandro U, Olaleye BO, Thomson MC, Langerock P, Greenwood BM, et al. C-reactive protein and haptoglobin in the evaluation of a community-based malaria control programme. Trans R Soc Trop Med Hyg 1996;90:10-4.  Back to cited text no. 5
[PUBMED]    
6. Hurt N, Smith T, Teuscher T, Tanner M. Do high levels of C-reactive protein in Tanzanian children indicate malaria morbidity. Clin Diagn Lab Immunol 1994;1:437-44.  Back to cited text no. 6
[PUBMED]    
7. Ansar W, Bandyopadhyay SM, Chowdhury S, Habib SH, Mandal C. Role of C-reactive protein in complement-mediated hemolysis in malaria. Glycoconj .J 2006;23:233-40.  Back to cited text no. 7
[PUBMED]    
8. Dongho Dongmo FF, Ngono Ngane RA, Gouado I, Pankoui Mfonkeu JB, Mbackop Kwemba V, Ngwa V, et al. Predictors of childhood severe malaria in a densely populated area: Douala, Cameroon. African Journal of Biotechnology 2011;10:6319-24.  Back to cited text no. 8
    
9. Bhattacharya S, Sharma C, Dhiman RC, Mitra AP. Climate change and malaria in India. Curr Sci 2006;90:369-75.  Back to cited text no. 9
    
10. Banik S, Adhikary AK. CRP Level as a prognostic indicator of morbidity and mortality in malaria. [Internet]. JAPI; 2009 [cited 2011 sept 2]. Available from http://www.japi.org/march_2009/tropical_medicine_poster_sessions.html.  Back to cited text no. 10
    
11. Gillespie SH, Dow C, Raynes JG, Behrens RH, Chiodini PL, McAdam KP. Measurement of acute phase proteins for assessing severity of Plasmodium falciparum malaria. J Clin Pathol 1991;44:228-31.  Back to cited text no. 11
[PUBMED]    
12. Andrade BB, Reis-Filho A, Souza-Neto SM, Clarêncio J, Camargo LM, Barral A, et al. Severe Plasmodium vivax malaria exhibits marked inflammatory imbalance. Malar J 2010;9:13.  Back to cited text no. 12
    
13. O'Donnell A, Fowkes FJ, Allen SJ, Imrie H, Alpers MP, Weatherall DJ, et al. The acute phase response in children with mild and severe malaria in Papua New Guinea. Trans R Soc Trop Med Hyg 2009;103:679-86.   Back to cited text no. 13
    
14. Felix Yh, Hugues A, David K, Adou Y, Brice BK, Dagui M, et al. Assessment of inflammatory and immunity proteins during falciparum malaria infection in children of Côte d'Ivoire. Am J Sci Ind Res 2010;1:233-7.  Back to cited text no. 14
    
15. Robinson P, Jenney AW, Tachado M, Yung A, Manitta J, Taylor K, et al. Imported malaria treated in Melbourne, Australia: Epidemiology and clinical features in 246 patients. J Travel Med 2001;8:76-81.  Back to cited text no. 15
    
16. Malaria: Disease Burden in SEA Region [internet].WHO publication; 2011[Updated 2011 Jan 18; Cited 2011 Sept 6]. WHO Regional Office for South-East Asia; [about 2 screens]. Available online at http://www.searo.who.int/en/Section10/Section21/Section340_4018.htm  Back to cited text no. 16
    
 
Advanced Biomedical Research
Volume 2012, August
August 2012
Pages 1-5