Haematological consequences of acute uncomplicated falciparum malaria: a WorldWide Antimalarial Resistance Network pooled analysis of individual patient data

Rashid Mansoor; Robert Commons; Nicholas Douglas; Benjamin Abuaku; Jane Achan; Ishag Adam; George Adjei; Martin Adjuik; Bereket Alemayehu; Richard Allan; Elizabeth Allen; Anupkumar Anvikar; Emmanuel Arinaitwe; Elizabeth Ashley; Hazel Ashurst; Puji Asih; Nathan Bakyaita; Hubert Barennes; Karen Barnes; Leonardo Basco; Quique Bassat; Elisabeth Baudin; David Bell; Delia Bethell; Anders Bjorkman; Caroline Boulton; Teun Bousema; Philippe Brasseur; Hasifa Bukirwa; Rebekah Burrow; Verena Carrara; Michel Cot; Umberto D’Alessandro; Debashish Das; Sabyasachi Das; Timothy Davis; Meghna Desai; Abdoulaye Djimde; Arjen Dondorp; Grant Dorsey; Chris Drakeley; Stephan Duparc; Emmanuelle Espié; Jean-Francois Etard; Catherine Falade; Jean Francois Faucher; Scott Filler; Carole Fogg; Mark Fukuda; Oumar Gaye; Blaise Genton; Awab Ghulam Rahim; Julius Gilayeneh; Raquel Gonzalez; Rebecca Grais; Francesco Grandesso; Brian Greenwood; Anastasia Grivoyannis; Christoph Hatz; Eva Maria Hodel; Georgina Humphreys; Jimee Hwang; Deus Ishengoma; Elizabeth Juma; S. Patrick Kachur; Piet Kager; Erasmus Kamugisha; Moses Kamya; Corine Karema; Kassoum Kayentao; Adama Kazienga; Jean-René Kiechel; Poul-Erik Kofoed; Kwadwo Koram; Peter Kremsner; David Lalloo; Moses Laman; Sue Lee; Bertrand Lell; Amelia Maiga; Andreas Mårtensson; Mayfong Mayxay; Wilfred Mbacham; Rose Mcgready; Hervé Menan; Didier Ménard; Frank Mockenhaupt; Brioni Moore; Olaf Müller; Alain Nahum; Jean-Louis Ndiaye; Paul Newton; Billy Ngasala; Frederic Nikiema; Akindeh Nji; Harald Noedl; Francois Nosten; Bernhards Ogutu; Olusola Ojurongbe; Lyda Osorio; WorldWide Antimalarial Resistance

doi:10.1186/s12916-022-02265-9

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Haematological consequences of acute uncomplicated falciparum malaria: a WorldWide Antimalarial Resistance Network pooled analysis of individual patient data

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Haematological consequences of acute uncomplicated falciparum malaria: a WorldWide Antimalarial Resistance Network pooled analysis of individual patient data

Rashid Mansoor, Robert Commons, Nicholas Douglas, Benjamin Abuaku, Jane Achan, Ishag Adam, George Adjei, Martin Adjuik, Bereket Alemayehu, Richard Allan, …

BMC medicine, Vol.20(1), pp.85-85

07/03/2022

DOI: https://doi.org/10.1186/s12916-022-02265-9

PMID: 35249546

Abstract

Bacteriology

Cardiology and cardiovascular system

Emerging diseases

Human health and pathology

Infectious diseases

Life Sciences

Microbiology and Parasitology

Parasitology

Virology

Abstract Background Plasmodium falciparum malaria is associated with anaemia-related morbidity, attributable to host, parasite and drug factors. We quantified the haematological response following treatment of uncomplicated P. falciparum malaria to identify the factors associated with malarial anaemia. Methods Individual patient data from eligible antimalarial efficacy studies of uncomplicated P. falciparum malaria, available through the WorldWide Antimalarial Resistance Network data repository prior to August 2015, were pooled using standardised methodology. The haematological response over time was quantified using a multivariable linear mixed effects model with nonlinear terms for time, and the model was then used to estimate the mean haemoglobin at day of nadir and day 7. Multivariable logistic regression quantified risk factors for moderately severe anaemia (haemoglobin < 7 g/dL) at day 0, day 3 and day 7 as well as a fractional fall ≥ 25% at day 3 and day 7. Results A total of 70,226 patients, recruited into 200 studies between 1991 and 2013, were included in the analysis: 50,859 (72.4%) enrolled in Africa, 18,451 (26.3%) in Asia and 916 (1.3%) in South America. The median haemoglobin concentration at presentation was 9.9 g/dL (range 5.0–19.7 g/dL) in Africa, 11.6 g/dL (range 5.0–20.0 g/dL) in Asia and 12.3 g/dL (range 6.9–17.9 g/dL) in South America. Moderately severe anaemia (Hb < 7g/dl) was present in 8.4% (4284/50,859) of patients from Africa, 3.3% (606/18,451) from Asia and 0.1% (1/916) from South America. The nadir haemoglobin occurred on day 2 post treatment with a mean fall from baseline of 0.57 g/dL in Africa and 1.13 g/dL in Asia. Independent risk factors for moderately severe anaemia on day 7, in both Africa and Asia, included moderately severe anaemia at baseline (adjusted odds ratio (AOR) = 16.10 and AOR = 23.00, respectively), young age (age < 1 compared to ≥ 12 years AOR = 12.81 and AOR = 6.79, respectively), high parasitaemia (AOR = 1.78 and AOR = 1.58, respectively) and delayed parasite clearance (AOR = 2.44 and AOR = 2.59, respectively). In Asia, patients treated with an artemisinin-based regimen were at significantly greater risk of moderately severe anaemia on day 7 compared to those treated with a non-artemisinin-based regimen (AOR = 2.06 [95%CI 1.39–3.05], p < 0.001). Conclusions In patients with uncomplicated P. falciparum malaria, the nadir haemoglobin occurs 2 days after starting treatment. Although artemisinin-based treatments increase the rate of parasite clearance, in Asia they are associated with a greater risk of anaemia during recovery.

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Title: Haematological consequences of acute uncomplicated falciparum malaria: a WorldWide Antimalarial Resistance Network pooled analysis of individual patient data
Creators - without role: Rashid Mansoor - WorldWide Antimalarial Resistance Network Falciparum Haematology Study Group
Robert Commons - WorldWide Antimalarial Resistance Network Falciparum Haematology Study Group
Nicholas Douglas - WorldWide Antimalarial Resistance Network Falciparum Haematology Study Group
Benjamin Abuaku - WorldWide Antimalarial Resistance Network Falciparum Haematology Study Group
Jane Achan - WorldWide Antimalarial Resistance Network Falciparum Haematology Study Group
Ishag Adam - WorldWide Antimalarial Resistance Network Falciparum Haematology Study Group
George Adjei - WorldWide Antimalarial Resistance Network Falciparum Haematology Study Group
Martin Adjuik - WorldWide Antimalarial Resistance Network Falciparum Haematology Study Group
Bereket Alemayehu - WorldWide Antimalarial Resistance Network Falciparum Haematology Study Group
Richard Allan - WorldWide Antimalarial Resistance Network Falciparum Haematology Study Group
Elizabeth Allen - WorldWide Antimalarial Resistance Network Falciparum Haematology Study Group
Anupkumar Anvikar - WorldWide Antimalarial Resistance Network Falciparum Haematology Study Group
Emmanuel Arinaitwe - WorldWide Antimalarial Resistance Network Falciparum Haematology Study Group
Elizabeth Ashley - WorldWide Antimalarial Resistance Network Falciparum Haematology Study Group
Hazel Ashurst - WorldWide Antimalarial Resistance Network Falciparum Haematology Study Group
Puji Asih - WorldWide Antimalarial Resistance Network Falciparum Haematology Study Group
Nathan Bakyaita - WorldWide Antimalarial Resistance Network Falciparum Haematology Study Group
Hubert Barennes - WorldWide Antimalarial Resistance Network Falciparum Haematology Study Group
Karen Barnes - WorldWide Antimalarial Resistance Network Falciparum Haematology Study Group
Leonardo Basco - WorldWide Antimalarial Resistance Network Falciparum Haematology Study Group
Quique Bassat - WorldWide Antimalarial Resistance Network Falciparum Haematology Study Group
Elisabeth Baudin - WorldWide Antimalarial Resistance Network Falciparum Haematology Study Group
David Bell - WorldWide Antimalarial Resistance Network Falciparum Haematology Study Group
Delia Bethell - WorldWide Antimalarial Resistance Network Falciparum Haematology Study Group
Anders Bjorkman - WorldWide Antimalarial Resistance Network Falciparum Haematology Study Group
Caroline Boulton - WorldWide Antimalarial Resistance Network Falciparum Haematology Study Group
Teun Bousema - WorldWide Antimalarial Resistance Network Falciparum Haematology Study Group
Philippe Brasseur - WorldWide Antimalarial Resistance Network Falciparum Haematology Study Group
Hasifa Bukirwa - WorldWide Antimalarial Resistance Network Falciparum Haematology Study Group
Rebekah Burrow - WorldWide Antimalarial Resistance Network Falciparum Haematology Study Group
Verena Carrara - WorldWide Antimalarial Resistance Network Falciparum Haematology Study Group
Michel Cot - WorldWide Antimalarial Resistance Network Falciparum Haematology Study Group
Umberto D’Alessandro - WorldWide Antimalarial Resistance Network Falciparum Haematology Study Group
Debashish Das - WorldWide Antimalarial Resistance Network Falciparum Haematology Study Group
Sabyasachi Das - WorldWide Antimalarial Resistance Network Falciparum Haematology Study Group
Timothy Davis - WorldWide Antimalarial Resistance Network Falciparum Haematology Study Group
Meghna Desai - WorldWide Antimalarial Resistance Network Falciparum Haematology Study Group
Abdoulaye Djimde - WorldWide Antimalarial Resistance Network Falciparum Haematology Study Group
Arjen Dondorp - WorldWide Antimalarial Resistance Network Falciparum Haematology Study Group
Grant Dorsey - WorldWide Antimalarial Resistance Network Falciparum Haematology Study Group
Chris Drakeley - WorldWide Antimalarial Resistance Network Falciparum Haematology Study Group
Stephan Duparc - WorldWide Antimalarial Resistance Network Falciparum Haematology Study Group
Emmanuelle Espié - WorldWide Antimalarial Resistance Network Falciparum Haematology Study Group
Jean-Francois Etard - WorldWide Antimalarial Resistance Network Falciparum Haematology Study Group
Catherine Falade - WorldWide Antimalarial Resistance Network Falciparum Haematology Study Group
Jean Francois Faucher - WorldWide Antimalarial Resistance Network Falciparum Haematology Study Group
Scott Filler - WorldWide Antimalarial Resistance Network Falciparum Haematology Study Group
Carole Fogg - WorldWide Antimalarial Resistance Network Falciparum Haematology Study Group
Mark Fukuda - WorldWide Antimalarial Resistance Network Falciparum Haematology Study Group
Oumar Gaye - WorldWide Antimalarial Resistance Network Falciparum Haematology Study Group
Blaise Genton - WorldWide Antimalarial Resistance Network Falciparum Haematology Study Group
Awab Ghulam Rahim - WorldWide Antimalarial Resistance Network Falciparum Haematology Study Group
Julius Gilayeneh - WorldWide Antimalarial Resistance Network Falciparum Haematology Study Group
Raquel Gonzalez - WorldWide Antimalarial Resistance Network Falciparum Haematology Study Group
Rebecca Grais - WorldWide Antimalarial Resistance Network Falciparum Haematology Study Group
Francesco Grandesso - WorldWide Antimalarial Resistance Network Falciparum Haematology Study Group
Brian Greenwood - WorldWide Antimalarial Resistance Network Falciparum Haematology Study Group
Anastasia Grivoyannis - WorldWide Antimalarial Resistance Network Falciparum Haematology Study Group
Christoph Hatz - WorldWide Antimalarial Resistance Network Falciparum Haematology Study Group
Eva Maria Hodel - WorldWide Antimalarial Resistance Network Falciparum Haematology Study Group
Georgina Humphreys - WorldWide Antimalarial Resistance Network Falciparum Haematology Study Group
Jimee Hwang - WorldWide Antimalarial Resistance Network Falciparum Haematology Study Group
Deus Ishengoma - WorldWide Antimalarial Resistance Network Falciparum Haematology Study Group
Elizabeth Juma - WorldWide Antimalarial Resistance Network Falciparum Haematology Study Group
S. Patrick Kachur - WorldWide Antimalarial Resistance Network Falciparum Haematology Study Group
Piet Kager - WorldWide Antimalarial Resistance Network Falciparum Haematology Study Group
Erasmus Kamugisha - WorldWide Antimalarial Resistance Network Falciparum Haematology Study Group
Moses Kamya - WorldWide Antimalarial Resistance Network Falciparum Haematology Study Group
Corine Karema - WorldWide Antimalarial Resistance Network Falciparum Haematology Study Group
Kassoum Kayentao - WorldWide Antimalarial Resistance Network Falciparum Haematology Study Group
Adama Kazienga - WorldWide Antimalarial Resistance Network Falciparum Haematology Study Group
Jean-René Kiechel - WorldWide Antimalarial Resistance Network Falciparum Haematology Study Group
Poul-Erik Kofoed - WorldWide Antimalarial Resistance Network Falciparum Haematology Study Group
Kwadwo Koram - WorldWide Antimalarial Resistance Network Falciparum Haematology Study Group
Peter Kremsner - WorldWide Antimalarial Resistance Network Falciparum Haematology Study Group
David Lalloo - WorldWide Antimalarial Resistance Network Falciparum Haematology Study Group
Moses Laman - WorldWide Antimalarial Resistance Network Falciparum Haematology Study Group
Sue Lee - WorldWide Antimalarial Resistance Network Falciparum Haematology Study Group
Bertrand Lell - WorldWide Antimalarial Resistance Network Falciparum Haematology Study Group
Amelia Maiga - WorldWide Antimalarial Resistance Network Falciparum Haematology Study Group
Andreas Mårtensson - WorldWide Antimalarial Resistance Network Falciparum Haematology Study Group
Mayfong Mayxay - WorldWide Antimalarial Resistance Network Falciparum Haematology Study Group
Wilfred Mbacham - WorldWide Antimalarial Resistance Network Falciparum Haematology Study Group
Rose Mcgready - WorldWide Antimalarial Resistance Network Falciparum Haematology Study Group
Hervé Menan - WorldWide Antimalarial Resistance Network Falciparum Haematology Study Group
Didier Ménard - WorldWide Antimalarial Resistance Network Falciparum Haematology Study Group
Frank Mockenhaupt - WorldWide Antimalarial Resistance Network Falciparum Haematology Study Group
Brioni Moore - WorldWide Antimalarial Resistance Network Falciparum Haematology Study Group
Olaf Müller - WorldWide Antimalarial Resistance Network Falciparum Haematology Study Group
Alain Nahum - WorldWide Antimalarial Resistance Network Falciparum Haematology Study Group
Jean-Louis Ndiaye - WorldWide Antimalarial Resistance Network Falciparum Haematology Study Group
Paul Newton - WorldWide Antimalarial Resistance Network Falciparum Haematology Study Group
Billy Ngasala - WorldWide Antimalarial Resistance Network Falciparum Haematology Study Group
Frederic Nikiema - WorldWide Antimalarial Resistance Network Falciparum Haematology Study Group
Akindeh Nji - WorldWide Antimalarial Resistance Network Falciparum Haematology Study Group
Harald Noedl - WorldWide Antimalarial Resistance Network Falciparum Haematology Study Group
Francois Nosten - WorldWide Antimalarial Resistance Network Falciparum Haematology Study Group
Bernhards Ogutu - WorldWide Antimalarial Resistance Network Falciparum Haematology Study Group
Olusola Ojurongbe - WorldWide Antimalarial Resistance Network Falciparum Haematology Study Group
Lyda Osorio - WorldWide Antimalarial Resistance Network Falciparum Haematology Study Group
WorldWide Antimalarial Resistance
Publication Details: BMC medicine, Vol.20(1), pp.85-85
Publisher: BioMed Central
Identifiers: 9929046908331
Academic Unit: Qassim University
Language: English
Resource Type: Journal article