Analysis of factors and warning indicators for the intensification of imported malaria in Changsha

doi:10.12140/j.issn.1000-7423.2024.06.010

Abstract

Abstract:

Objective To analyze the characteristics of imported malaria in Changsha and explore the influencing factors and early warning indicators of severe malaria patients in combination with laboratory indicators. Methods A retrospective analysis was conducted on the case data of malaria patients hospitalized in the First Hospital of Changsha from 2012 to 2023. Differences between non-severe and severe malaria patients were compared. Bivariate correlation-Spearman correlation coefficient and logistic regression analysis were used to observe the correlation and influence degree between indicators and severe malaria. Indicators strongly related to prognosis were screened to identify independent impact factors for the progression of malaria patients to severe cases. Receiver operating characteristic (ROC) curve analysis was performed to assess the efficacy of individual and combined indicators in early prediction of severe malaria, and the area under the curve (AUC) was calculated. Results Case data from 127 malaria patients were collected, which including 38 severe malaria patients and 89 non-severe patients. Compared with non-severe malaria patients, severe malaria patients had longer durations from onset to hospitalization [4.00 (2.75, 6.00) d] and longer hospitalization time [7.00 (4.75, 12.00) d] (Z = -2.20, -3.05, P < 0.05, P < 0.01). More severe malaria patients [78.9% (30/38)] were presenting with occult blood in urine (χ² = 18.67, P < 0.01). They had lower red blood cell count [4.11 (3.46, 4.65) × 10¹²/L], platelet count [(53.50 ± 53.73) × 10⁹/L] and albumin level [(34.99 ± 5.36) g/L] (Z = -2.37, t = 6.72, t = 4.10; P < 0.05, P < 0.01, P < 0.01), but higher levels of alanine aminotransferase (ALT) [53.50 (38.63, 73.75) U/L], aspartate aminotransferase (AST) [50.85 (34.00, 97.05) U/L], lactate dehydrogenase (LDH) [449.50 (321.50, 625.75) U/L], total bilirubin [(74.18 ± 78.09) μmol/L] and procalcitonin (PCT) [2.95 (0.91, 19.47) ng/ml] (Z = -3.51, Z = -3.48, Z = -3.58, t = -3.91, Z = -4.63; all P < 0.01) than non-severe patients. Durations from onset to hospitalization, hospitalization time, urinary occult blood and levels of ALT, AST, total bilirubin, LDH, and PCT were positively correlated with severe malaria (r > 0, all P < 0.05), while red blood cell count, platelet count and albumin level were negatively correlated with severe malaria (r < 0, all P < 0.05). Among them, platelet count was a good indicator of malaria severity (|r| ≥ 0.5, P < 0.01). Urinary occult blood, AST, total bilirubin, LDH, serum creatinine, urea nitrogen and PCT were risk factors for severe malaria (OR > 1, P < 0.05), while red blood cell count, platelet count, hemoglobin and albumin level were protective factors against severe malaria (OR < 1, P < 0.05). Platelet count and total bilirubin level were independent impact factors for the progression of malaria patients to severe cases (P < 0.05), with AUCs of 0.867 and 0.769, respectively. The AUC for the combined detection of the both was 0.900, which was higher than that for single indicator detection (P < 0.01). Conclusion Platelet count and total bilirubin level can serve as independent impact factors for early warning of severe malaria. Combined detection is more helpful than single detection for early warning of severe malaria.

Key words: Malaria, Imported, Severe illness, Influencing factors, Early warning

CLC Number:

R531.3

ZHOU Quan, WEI Chaoxia, CAI Chunlin, LI Jinqiang. Analysis of factors and warning indicators for the intensification of imported malaria in Changsha[J]. CHINESE JOURNAL OF PARASITOLOGY AND PARASITIC DISEASES, 2024, 42(6): 756-762.

Figures/Tables 6

Table 1

Comparison of characteristics and laboratory tests between non-severe malaria patients and severe malaria patients

指标 Index	非重症疟疾患者 Non-severe malaria patient （n = 89）	重症疟疾患者 Severe malaria patient （n = 38）	统计值 Statistical value	P值 P value
年龄/岁 Age/Year	40.20 ± 11.62	40.92 ± 9.86	-0.42^a	> 0.05
性别/例（占比） Gender/case (Percentage)			0.00^b	> 0.05
男 Male	86（96.6%）	37（97.4%）
女 Female	3（3.4%）	1（2.6%）
发病到住院时间间隔/d Duration from onset to hospitalization/d	3.00（2.00，4.00）	4.00（2.75，6.00）	-2.20^c	< 0.05
住院时间/d Hospitalization time/d	4.50（3.00，7.00）	7.00（4.75，12.00）	-3.05^c	< 0.01
基础肝病/例（占比） Basic liver disease/case (Percentage)			0.22^b	> 0.05
有 Yes	20（22.5%）	10（26.3%）
无 None	69（77.5%）	28（73.7%）
尿隐血/例（占比） Urinary occult blood/case (Percentage)			18.67^b	< 0.01
有 Yes	33（37.1%）	30（78.9%）
无 None	56（62.9%）	8（21.1%）
白细胞/ × 10⁹L White blood cell/ × 10⁹L	5.61（4.73，7.48）	5.57（3.73，8.52）	-0.74^c	> 0.05
红细胞/ × 10¹²L Red blood cell/ × 10¹²L	4.46（4.05，4.70）	4.11（3.46，4.65）	-2.37^c	< 0.05
血红蛋白/g·L^-1Hemoglobin/g·L^-1	130.33 ± 18.29	121.92 ± 25.92	1.91^a	> 0.05
血小板/ × 10⁹L Platelet/ × 10⁹L	124.97 ± 55.76	53.50 ± 53.73	6.72^a	< 0.01
丙氨酸转氨酶/U·L^-1 Alanine aminotransferase/U·L^-1	32.00（22.00，54.75）	53.50（38.63，73.75）	-3.51^c	< 0.01
天冬氨酸转氨酶/U·L^-1 Aspartate aminotransferase/U·L^-1	34.00（23.00，54.35）	50.85（34.00，97.05）	-3.48^c	< 0.01
白蛋白/g·L^-1 Albumin/g·L^-1	38.58 ± 4.24	34.99 ± 5.36	4.10^a	< 0.01
总胆红素/μmol·L^-1 Total bilirubin/μmol·L^-1	24.36 ± 10.55	74.18 ± 78.09	-3.91^a	< 0.01
乳酸脱氢酶/U·L^-1 Lactate dehydrogenase/U·L^-1	310.00（249.50，406.25）	449.50（321.50，625.75）	-3.58^c	< 0.01
血清肌酐/μmol·L^-1 Serum creatinine/μmol·L^-1	74.00（65.23，84.00）	77.50（62.00，137.70）	-1.28^c	> 0.05
尿素氮/mmol·L^-1 Urea nitrogen/mmol·L^-1	5.80（5.20，6.70）	6.20（4.95，11.81）	-1.33^c	> 0.05
C-反应蛋白/mg·ml^-1 C-reactive protein/mg·ml^-1	53.45（35.63，76.10）	66.65（34.53，77.98）	-0.87^c	> 0.05
降钙素原/ng·ml^-1 Procalcitonin/ng·ml^-1	0.74（0.31，1.65）	2.95（0.91，19.47）	-4.63^c	< 0.01

Table 1

Table 2

Table 3

Table 4

Table 5

Fig. 1

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指标 Index	r值 r value	P值 P value
年龄 Age	0.042	> 0.05
性别 Gender	-0.019	> 0.05
发病到住院时间间隔 Duration from onset to hospitalization	0.196	< 0.05
住院时间 Hospitalization time	0.272	< 0.01
基础肝病 Basic liver disease	0.041	> 0.05
尿隐血 Urinary occult blood	0.383	< 0.01
白细胞 White blood cell	-0.065	> 0.05
红细胞 Red blood cell	-0.211	< 0.05
血红蛋白 Hemoglobin	-0.160	> 0.05
血小板 Platelet	-0.582	< 0.01
丙氨酸转氨酶 Alanine aminotransferase	0.314	< 0.01
天冬氨酸转氨酶 Aspartate aminotransferase	0.311	< 0.01
白蛋白 Albumin	-0.330	< 0.01
总胆红素 Total bilirubin	0.426	< 0.01
乳酸脱氢酶 Lactate dehydrogenase	0.318	< 0.01
血清肌酐 Serum creatinine	0.114	> 0.05
尿素氮 Urea nitrogen	0.118	> 0.05
C-反应蛋白 C-reactive protein	0.078	> 0.05
降钙素原 Procalcitonin	0.412	< 0.01

指标 Index	系数B Regression coefficient B	标准误 Standard error	Wald值 Wald value	自由度 Degree of freedom	P值 P value	OR（95% CI）
年龄 Age	0.007	0.018	0.155	1	> 0.05	1.007（0.973~1.042）
性别 Gender	-0.255	1.171	0.047	1	> 0.05	0.775（0.078~7.695）
发病到住院时间间隔 Duration from onset to hospitalization	-0.020	0.029	0.461	1	> 0.05	0.981（0.927~1.037）
基础肝病 Basic liver disease	0.209	0.447	0.218	1	> 0.05	1.232（0.513~2.962）
尿隐血 Urinary occult blood	1.851	0.454	16.585	1	< 0.01	6.364（2.612~15.506）
白细胞 White blood cell	-0.012	0.063	0.037	1	> 0.05	0.988（0.873~1.118）
红细胞 Red blood cell	-0.687	0.280	6.040	1	< 0.05	0.503（0.291~0.870）
血红蛋白 Hemoglobin	-0.019	0.009	4.332	1	< 0.05	0.981（0.963~0.999）
血小板 Platelet	-0.032	0.006	25.204	1	< 0.01	0.969（0.957~0.981）
丙氨酸转氨酶 Alanine aminotransferase	0.007	0.004	3.678	1	> 0.05	1.007（1.000~1.015）
天冬氨酸转氨酶 Aspartate aminotransferase	0.016	0.005	8.609	1	< 0.01	1.016（1.005~1.027）
白蛋白 Albumin	-0.168	0.046	13.328	1	< 0.01	0.845（0.772~0.925）
总胆红素 Total bilirubin	0.067	0.016	16.891	1	< 0.01	1.069（1.036~1.104）
乳酸脱氢酶 Lactate dehydrogenase	0.004	0.001	12.375	1	< 0.01	1.004（1.002~1.007）
血清肌酐 Serum creatinine	0.020	0.007	7.672	1	< 0.01	1.020（1.006~1.034）
尿素氮 Urea nitrogen	0.212	0.067	10.05	1	< 0.01	1.236（1.084~1.409）
C-反应蛋白 C-reactive protein	0.011	0.006	2.961	1	> 0.05	1.011（0.998~1.024）
降钙素原 Procalcitonin	0.136	0.041	11.124	1	< 0.01	1.145（1.057~1.240）

指标 Index	系数B Regression coefficient B	标准误 Standard error	Wald值 Wald value	自由度 Degree of freedom	P值 P value	OR（95% CI）
尿隐血 Urinary occult blood	0.793	0.611	1.683	1	> 0.05	2.210（0.667~7.321）
红细胞 Red blood cell	-0.236	0.379	0.389	1	> 0.05	0.789（0.376~1.660）
血小板 Platelet	-0.024	0.008	8.442	1	< 0.01	0.977（0.961~0.992）
天冬氨酸转氨酶 Aspartate aminotransferase	-0.001	0.009	0.012	1	> 0.05	0.999（0.982~1.016）
白蛋白 Albumin	-0.038	0.065	0.345	1	> 0.05	0.963（0.848~1.093）
总胆红素 Total bilirubin	0.047	0.020	5.811	1	< 0.05	1.048（1.009~1.089）
乳酸脱氢酶 Lactate dehydrogenase	-0.001	0.002	0.697	1	> 0.05	0.999（0.995~1.002）
降钙素原 Procalcitonin	0.059	0.049	1.475	1	> 0.05	1.061（0.964~1.167）

指标 Index	最佳阈值 Optimal threshold	曲线下面积 AUC	P值 P value	敏感度/% Sensitivity/%	特异度/% Specificity/%	95% CI
血小板 Platelet	54.50 × 10⁹/L	0.867	< 0.01	76.3	97.8	0.778~0.956
总胆红素 Total bilirubin	45.50 μmol/L	0.769	< 0.01	55.3	97.8	0.663~0.874
联合 Combination	0.45	0.900	< 0.01	78.9	96.6	0.820~0.981