Abstract:

Objective To understand the clinical characteristics and predictive indicators of severe imported malaria for a basis in early identification of this infection. Methods Clinical data were collected from the confirmed imported malaria cases treated on hospitalization basis in the Department of Infectious Diseases at the First Affiliated Hospital of Anhui Medical University between December 2013 and September 2024, and the general information, clinical features and laboratory findings of severe and non-severe malaria patients were comparatively analyzed. Logistic regression model and receiver operating characteristic (ROC) curve analysis were used to evaluate the predictive value of relevant laboratory indicators for severe malaria. Results A total of 76 confirmed cases of imported malaria were enrolled, including 23 severe cases and 53 non-severe cases. The infections were primarily imported from African countries (97.37%, 74/76). Fifty-eight cases of Plasmodium falciparum (P. falciparum) infection (76.32%), with a higher proportion of P. falciparum infection in the severe group than in the non-severe group (95.65% vs. 67.92%, χ2 =6.82, P<0.05). The incidences of chills/rigors and Coca-Cola colored urine were higher in the severe group. Compared to the non-severe group, patients in the severe group had significantly higher levels of total bilirubin (TBIL), alanine amino-transferase (ALT), aspartate amino-transferase (AST), creatinine (Cr), blood urea nitrogen (BUN), and procalcitonin (PCT), yet markedly lower hemoglobin (Hb) level and platelet (PLT) counts (all P<0.05). The ROC curve of predictive factors of severe malaria showed that the area under the curve (AUC) of TBIL was 0.896 (95% CI: 0.810-0.982) (P<0.05). The optimal cut-off value for TBIL, determined at the maximum Youden index, was 48.6 μmol/L, yielding a sensitivity of 73.9% and specificity of 96.2% for predicting severe malaria. Conclusion Patients with severe malaria are prone to significant liver and kidney damage, characterized by decreased PLT counts and Hb, and elevated TBIL levels. TBIL has value in predicting severe malaria.

Key words: Imported malaria, Severe malaria, Clinical characteristic, Predictive indicator