title: Imported falciparum malaria in adults: host- and parasite-related factors associated with severity. The French prospective multicenter PALUREA cohort study.
abstract: OBJECTIVE
  Prospective data on potential factors associated with severity of imported Plasmodium falciparum malaria are lacking. We evaluated whether several host- and parasite-related biomarkers may improve early severity evaluation.
  
  
  METHODS
  Prospective multicenter observational study comparing uncomplicated and severe imported falciparum malaria in adults conducted in France in 52 units, from 2007 to 2010. Association of several host- and parasite-related biomarkers with severity of malaria was tested using univariate and multivariate analyses.
  
  
  RESULTS
  Of 295 patients, 140 had uncomplicated malaria and 155 severe malaria (including very severe and less severe cases according to predefined criteria). Curative intravenous quinine treatment was used in 154/155 patients with severe malaria and atovaquone/proguanil in 74 % of patients with uncomplicated malaria. Hospital mortality was 5.2 % (8 patients), all in the severe malaria group. Among host-related biomarkers, CRP, procalcitonin, and sTREM-1 were significantly higher and albumin was significantly lower in severe versus uncomplicated malaria; only the last three biomarkers also differed significantly between the very and less severe malaria groups. Among parasite-related biomarkers, only plasma PfHRP2 was significantly higher in severe versus uncomplicated malaria and in very severe versus less severe malaria; parasitemia did not differ between very and less severe malaria. By multivariate analysis, only lower plasma albumin and higher sTREM-1 were associated with greater severity, with intermediate accuracies.
  
  
  CONCLUSIONS
  During imported malaria, the most useful biomarkers associated with severity seem to be plasma albumin and sTREM-1; and among parasite-related parameters, PfHRP2 was more strongly associated with severity than parasitemia was.
authors.affiliation: Service de Réanimation Médico-Chirurgicale, Centre Hospitalier de Versailles, 177 rue de Versailles, 78157, Le Chesnay, France. fbruneel@ch-versailles.fr.
authors.forename: Fabrice
authors.initials: F
authors.lastname: Bruneel
authors.affiliation: Université Paris Diderot, Sorbonne Paris Cité, UMR 1123, 75018, Paris, France.|Département d'Epidémiologie et Recherche Clinique, CIC-EC 1425, AP-HP, Hôpital Bichat, 75018, Paris, France.|INSERM, CIC-EC 1425, U1123, 75018, Paris, France.
authors.forename: Florence
authors.initials: F
authors.lastname: Tubach
authors.affiliation: Service de Réanimation, Centre Hospitalier Universitaire Cochin Saint-Vincent de Paul, AP-HP, 75014, Paris, France.
authors.forename: Jean-Paul
authors.initials: JP
authors.lastname: Mira
authors.affiliation: Service de Parasitologie, Centre Hospitalier Universitaire Bichat-Claude Bernard, AP-HP, 75018, Paris, France.
authors.forename: Sandrine
authors.initials: S
authors.lastname: Houze
authors.affiliation: Service de Réanimation Médicale, Hôpital Central, Centre Hospitalier Universitaire de Nancy, 54035, Nancy, France.
authors.forename: Sebastien
authors.initials: S
authors.lastname: Gibot
authors.affiliation: Unité d'Hémato-Immunologie, Centre Hospitalier Universitaire Bichat-Claude Bernard, AP-HP, 75018, Paris, France.
authors.forename: Marie-Genevieve
authors.initials: MG
authors.lastname: Huisse
authors.affiliation: Service de Réanimation Médicale et Toxicologique, Centre Hospitalier Universitaire Lariboisière, AP-HP, 75010, Paris, France.
authors.forename: Bruno
authors.initials: B
authors.lastname: Megarbane
authors.affiliation: Service d'Accueil des Urgences, Centre Hospitalier Universitaire Bichat-Claude Bernard, AP-HP, 75018, Paris, France.
authors.forename: Christophe
authors.initials: C
authors.lastname: Choquet
authors.affiliation: Service de Réanimation Médicale, Centre Hospitalier Universitaire Gui de Chauliac, 34295, Montpellier, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Corne
authors.affiliation: Service d'Anesthésiologie et Réanimation, Hôpital d'Instruction des Armées Laveran, 13384, Marseille, France.
authors.forename: Eric
authors.initials: E
authors.lastname: Peytel
authors.affiliation: Service de Réanimation Médicale Polyvalente, Centre Hospitalier Universitaire de Nantes, Hotel Dieu, 44093, Nantes, France.
authors.forename: Daniel
authors.initials: D
authors.lastname: Villers
authors.affiliation: Service de Réanimation Médicale et Infectieuse, Centre Hospitalier Universitaire de Rennes, Hôpital Pontchaillou, 35033, Rennes, France.
authors.forename: Christophe
authors.initials: C
authors.lastname: Camus
authors.affiliation: Service de Maladies Infectieuses et Tropicales, Centre Hospitalier Universitaire Avicenne, AP-HP, 93009, Bobigny, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Bouchaud
authors.affiliation: Service de Maladies Infectieuses et Tropicales, Centre Hospitalier Universitaire de la Pitié-Salpêtrière, AP-HP, 75013, Paris, France.
authors.forename: Eric
authors.initials: E
authors.lastname: Caumes
authors.affiliation: Service de Maladies Infectieuses et Tropicales, Centre Hospitalier Universitaire de Saint- Antoine, AP-HP, 75012, Paris, France.
authors.forename: Pierre-Marie
authors.initials: PM
authors.lastname: Girard
authors.affiliation: Service de Maladies Infectieuses et Tropicales, Hôpital d'Instruction des Armées Laveran, 13384, Marseille, France.
authors.forename: Fabrice
authors.initials: F
authors.lastname: Simon
authors.affiliation: Unité de Biochimie Clinique, Centre Hospitalier Universitaire Bichat-Claude Bernard, AP-HP, 75018, Paris, France.
authors.forename: Antoine
authors.initials: A
authors.lastname: Kalloumeh
authors.affiliation: Département d'Epidémiologie et Recherche Clinique, CIC-EC 1425, AP-HP, Hôpital Bichat, 75018, Paris, France.|INSERM, CIC-EC 1425, U1123, 75018, Paris, France.
authors.forename: Carine
authors.initials: C
authors.lastname: Roy
authors.affiliation: Service de Parasitologie, Centre Hospitalier Universitaire Avicenne, AP-HP, 93009, Bobigny, France.
authors.forename: Remy
authors.initials: R
authors.lastname: Durand
authors.affiliation: Service de Parasitologie, Centre Hospitalier Universitaire Bichat-Claude Bernard, AP-HP, 75018, Paris, France.
authors.forename: Jacques
authors.initials: J
authors.lastname: Le Bras
authors.affiliation: Service de Maladies Infectieuses et Tropicales, Centre Hospitalier Universitaire Bichat-Claude Bernard, AP-HP, 75018, Paris, France.
authors.forename: Sophie
authors.initials: S
authors.lastname: Matheron
authors.affiliation: Service de Réanimation Médicale et Infectieuse, Centre Hospitalier Universitaire Bichat-Claude Bernard, AP-HP, 75018, Paris, France.
authors.forename: Michel
authors.initials: M
authors.lastname: Wolff
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D000818:Animals; D000953:Antigens, Protozoan / Q000097:blood*; D000962:Antimalarials / Q000627:therapeutic use*; D053626:Atovaquone / Q000627:therapeutic use; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000032:analysis; D002116:Calcitonin / Q000097:blood; D004338:Drug Combinations; D005260:Female; D005602:France; D006790:Host-Parasite Interactions; D006801:Humans; D016778:Malaria, Falciparum / Q000097:blood* / Q000188:drug therapy* / Q000469:parasitology; D008297:Male; D008875:Middle Aged; D018512:Parasitemia / Q000097:blood; D010963:Plasmodium falciparum; D002727:Proguanil / Q000627:therapeutic use; D011446:Prospective Studies; D015800:Protozoan Proteins / Q000097:blood*; D011803:Quinine / Q000627:therapeutic use*; D012720:Severity of Illness Index
chemical_list: D000953:Antigens, Protozoan; D000962:Antimalarials; D015415:Biomarkers; D004338:Drug Combinations; C514457:HRP-2 antigen, Plasmodium falciparum; D015800:Protozoan Proteins; C109496:atovaquone, proguanil drug combination; D002116:Calcitonin; D002097:C-Reactive Protein; D011803:Quinine; D002727:Proguanil; D053626:Atovaquone
keywords: Biomarkers; Intensive care; Malaria; Parasitemia; PfHRP2; Quinine