Predictive value of lymphocytopenia and the neutrophil-lymphocyte count ratio for severe imported malaria

Malaria Journal

Research

Mariana de Mendonça Melo¹  Marlies E van Wolfswinkel¹  Klaske Vliegenthart-Jongbloed¹  Perry J van Genderen²  Peter C Wever³  Matthew B McCall⁴  Jaap J van Hellemond⁵  Rob Koelewijn⁶ 

[1] Department of Internal Medicine, Harbour Hospital Rotterdam, Rotterdam, The Netherlands;Department of Internal Medicine, Harbour Hospital Rotterdam, Rotterdam, The Netherlands;Institute for Tropical Diseases, Harbour Hospital Rotterdam, Haringvliet 72, TG, 3011, Rotterdam, The Netherlands;Travel Clinic Havenziekenhuis, Rotterdam, The Netherlands;Department of Medical Microbiology and Infection Control, Jeroen Bosch Hospital, ’s-Hertogenbosch, The Netherlands;Department of Medical Microbiology and Infectious Diseases, Erasmus MC, Rotterdam, The Netherlands;Department of Medical Microbiology and Infectious Diseases, Erasmus MC, Rotterdam, The Netherlands;Laboratory of Parasitology, Harbour Hospital and Institute for Tropical Diseases, Rotterdam, The Netherlands;Laboratory of Parasitology, Harbour Hospital and Institute for Tropical Diseases, Rotterdam, The Netherlands;

关键词: Malaria;    Severity;    Falciparum;    NLCR;    Lymphocytopenia;    Leukocyte count;    Severe disease;    Marker;    Biomarker;   

DOI  :  10.1186/1475-2875-12-101

 received in 2012-12-31, accepted in 2013-03-09,  发布年份 2013

来源: Springer

【 摘 要 】

BackgroundLymphocytopenia has frequently been described in patients with malaria, but studies on its association with disease severity have yielded conflicting results. The neutrophil/lymphocyte count ratio (NLCR) has been introduced as a parameter for systemic inflammation in critically ill patients and was found, together with lymphocytopenia, to be a better predictor of bacteraemia than routine parameters like C-reactive protein and total leukocyte count. In the present study, the predictive value of the NLCR and lymphocytopenia for severe disease was evaluated in patients with imported malaria.MethodsAll patients diagnosed with malaria at the Harbour Hospital between January 1st 1999 and January 1st 2012 with differential white cell counts determined within the first 24 hours after admission were included in this retrospective study. Severe malaria was defined according to the WHO criteria. The performance of the NLCR and lymphocytopenia as a marker of severe malarial disease was compared back-to-back with that of C-reactive protein as a reference biomarker.ResultsA total of 440 patients (severe falciparum malaria n = 61, non-severe falciparum malaria n = 259, non-falciparum malaria n=120) were included in the study. Lymphocytopenia was present in 52% of all patients and the median NLCR of all patients was 3.2. Total lymphocyte counts and NLCR did not differ significantly between groups. A significant correlation of total leukocyte count and NLCR, but not lymphocyte count, with parasitaemia was found. ROC analysis revealed a good negative predictive value but a poor positive predictive value of both lymphocytopenia and NLCR and performance was inferior to that of C-reactive protein. After complete parasite clearance a significant rise in total leukocyte count and lymphocyte count and a significant decrease in NLCR was observed.ConclusionThe NLCR was found to correlate with parasitaemia, but both lymphocytopenia and the NLCR were inferior to C-reactive protein as markers for severe disease in patients with imported malaria. The NLCR and lymphocytopenia are not useful as predictive markers for severe disease in imported malaria in the acute care setting.

【 授权许可】

Unknown   
© van Wolfswinkel et al.; licensee BioMed Central Ltd. 2013. This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.