Does reduced oxygen delivery cause lactic acidosis in falciparum malaria? An observational study

Hugh W. Kingston; Aniruddha Ghose; Voravut Rungpradubvong; M. Trent Herdman; Katherine Plewes; Haruhiko Ishioka; Stije J. Leopold; Richard J. Maude; Benjamas Intharabut; Sanjib Mohanty; Nicholas P.J. Day; Nicholas J. White; Md Amir Hossain; Nicholas M. Anstey; Arjen M. Dondorp

doi:10.1186/s12936-019-2733-y

Does reduced oxygen delivery cause lactic acidosis in falciparum malaria? An observational study

Hugh W. Kingston, Aniruddha Ghose, Voravut Rungpradubvong, M. Trent Herdman, Katherine Plewes, Haruhiko Ishioka, Stije J. Leopold, Richard J. Maude, Benjamas Intharabut, Sanjib Mohanty, Nicholas P.J. Day, Nicholas J. White, Md Amir Hossain, Nicholas M. Anstey, Arjen M. Dondorp

Global and Tropical Health

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Abstract

Background: Lactic acidosis with an elevated lactate-pyruvate ratio suggesting anoxia is a common feature of severe falciparum malaria. High lactate levels are associated with parasitized erythrocyte sequestration in the microcirculation. To assess if there is an additional contribution to hyperlactataemia from relatively inadequate total oxygen delivery, oxygen consumption and delivery were investigated in patients with malaria.

Methods: Adult Bangladeshi and Indian patients with uncomplicated (N = 50) or severe (N = 46) falciparum malaria or suspected bacterial sepsis (N = 27) and healthy participants as controls (N = 26) were recruited at Chittagong Medical College Hospital, Chittagong, Bangladesh and Ispat General Hospital, Rourkela, India. Oxygen delivery (DO ₂ I) was estimated from pulse oximetry, echocardiographic estimates of cardiac index and haematocrit. Oxygen consumption (VO ₂ I) was estimated by expired gas collection.

Results: VO ₂ I was elevated in uncomplicated median (IQR) 185.1 ml/min/m ² (135-215.9) and severe malaria 192 ml/min/m ² (140.7-227.9) relative to healthy persons 107.9 ml/min/m ² (69.9-138.1) (both p < 0.001). Median DO ₂ I was similar in uncomplicated 515 ml/min/m ² (432-612) and severe 487 ml/min/m ² (382-601) malaria and healthy persons 503 ml/min/m ² (447-517) (p = 0.27 and 0.89, respectively). The VO ₂ /DO ₂ ratio was, therefore, increased by similar amounts in both uncomplicated 0.35 (0.28-0.44) and severe malaria 0.38 (0.29-0.48) relative to healthy participants 0.23 (0.17-0.28) (both p < 0.001). VO ₂ I, DO ₂ I and VO ₂ /DO ₂ did not correlate with plasma lactate concentrations in severe malaria.

Conclusions: Reduced total oxygen delivery is not a major contributor to lactic acidosis in severe falciparum malaria.

Original language	English
Article number	97
Pages (from-to)	1-7
Number of pages	7
Journal	Malaria Journal
Volume	18
DOIs	https://doi.org/10.1186/s12936-019-2733-y
Publication status	Published - 25 Mar 2019

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Kingston, H. W., Ghose, A., Rungpradubvong, V., Herdman, M. T., Plewes, K., Ishioka, H., Leopold, S. J., Maude, R. J., Intharabut, B., Mohanty, S., Day, N. P. J., White, N. J., Hossain, M. A., Anstey, N. M., & Dondorp, A. M. (2019). Does reduced oxygen delivery cause lactic acidosis in falciparum malaria? An observational study. Malaria Journal, 18, 1-7. Article 97. https://doi.org/10.1186/s12936-019-2733-y

@article{679989d8565840ed829cdbb9be58351a,

title = "Does reduced oxygen delivery cause lactic acidosis in falciparum malaria? An observational study",

abstract = " Background: Lactic acidosis with an elevated lactate-pyruvate ratio suggesting anoxia is a common feature of severe falciparum malaria. High lactate levels are associated with parasitized erythrocyte sequestration in the microcirculation. To assess if there is an additional contribution to hyperlactataemia from relatively inadequate total oxygen delivery, oxygen consumption and delivery were investigated in patients with malaria. Methods: Adult Bangladeshi and Indian patients with uncomplicated (N = 50) or severe (N = 46) falciparum malaria or suspected bacterial sepsis (N = 27) and healthy participants as controls (N = 26) were recruited at Chittagong Medical College Hospital, Chittagong, Bangladesh and Ispat General Hospital, Rourkela, India. Oxygen delivery (DO 2 I) was estimated from pulse oximetry, echocardiographic estimates of cardiac index and haematocrit. Oxygen consumption (VO 2 I) was estimated by expired gas collection. Results: VO 2 I was elevated in uncomplicated median (IQR) 185.1 ml/min/m 2 (135-215.9) and severe malaria 192 ml/min/m 2 (140.7-227.9) relative to healthy persons 107.9 ml/min/m 2 (69.9-138.1) (both p < 0.001). Median DO 2 I was similar in uncomplicated 515 ml/min/m 2 (432-612) and severe 487 ml/min/m 2 (382-601) malaria and healthy persons 503 ml/min/m 2 (447-517) (p = 0.27 and 0.89, respectively). The VO 2 /DO 2 ratio was, therefore, increased by similar amounts in both uncomplicated 0.35 (0.28-0.44) and severe malaria 0.38 (0.29-0.48) relative to healthy participants 0.23 (0.17-0.28) (both p < 0.001). VO 2 I, DO 2 I and VO 2 /DO 2 did not correlate with plasma lactate concentrations in severe malaria. Conclusions: Reduced total oxygen delivery is not a major contributor to lactic acidosis in severe falciparum malaria. ",

keywords = "Acidosis, lactic, Cardiac output, Haemodynamics, Malaria, Microcirculation, Oxygen consumption",

author = "Kingston, {Hugh W.} and Aniruddha Ghose and Voravut Rungpradubvong and Herdman, {M. Trent} and Katherine Plewes and Haruhiko Ishioka and Leopold, {Stije J.} and Maude, {Richard J.} and Benjamas Intharabut and Sanjib Mohanty and Day, {Nicholas P.J.} and White, {Nicholas J.} and Hossain, {Md Amir} and Anstey, {Nicholas M.} and Dondorp, {Arjen M.}",

year = "2019",

month = mar,

day = "25",

doi = "10.1186/s12936-019-2733-y",

language = "English",

volume = "18",

pages = "1--7",

journal = "Malaria Journal",

issn = "1475-2875",

publisher = "BioMed Central",

}

Kingston, HW, Ghose, A, Rungpradubvong, V, Herdman, MT, Plewes, K, Ishioka, H, Leopold, SJ, Maude, RJ, Intharabut, B, Mohanty, S, Day, NPJ, White, NJ, Hossain, MA, Anstey, NM & Dondorp, AM 2019, 'Does reduced oxygen delivery cause lactic acidosis in falciparum malaria? An observational study', Malaria Journal, vol. 18, 97, pp. 1-7. https://doi.org/10.1186/s12936-019-2733-y

TY - JOUR

T1 - Does reduced oxygen delivery cause lactic acidosis in falciparum malaria? An observational study

AU - Kingston, Hugh W.

AU - Ghose, Aniruddha

AU - Rungpradubvong, Voravut

AU - Herdman, M. Trent

AU - Plewes, Katherine

AU - Ishioka, Haruhiko

AU - Leopold, Stije J.

AU - Maude, Richard J.

AU - Intharabut, Benjamas

AU - Mohanty, Sanjib

AU - Day, Nicholas P.J.

AU - White, Nicholas J.

AU - Hossain, Md Amir

AU - Anstey, Nicholas M.

AU - Dondorp, Arjen M.

PY - 2019/3/25

Y1 - 2019/3/25

N2 - Background: Lactic acidosis with an elevated lactate-pyruvate ratio suggesting anoxia is a common feature of severe falciparum malaria. High lactate levels are associated with parasitized erythrocyte sequestration in the microcirculation. To assess if there is an additional contribution to hyperlactataemia from relatively inadequate total oxygen delivery, oxygen consumption and delivery were investigated in patients with malaria. Methods: Adult Bangladeshi and Indian patients with uncomplicated (N = 50) or severe (N = 46) falciparum malaria or suspected bacterial sepsis (N = 27) and healthy participants as controls (N = 26) were recruited at Chittagong Medical College Hospital, Chittagong, Bangladesh and Ispat General Hospital, Rourkela, India. Oxygen delivery (DO 2 I) was estimated from pulse oximetry, echocardiographic estimates of cardiac index and haematocrit. Oxygen consumption (VO 2 I) was estimated by expired gas collection. Results: VO 2 I was elevated in uncomplicated median (IQR) 185.1 ml/min/m 2 (135-215.9) and severe malaria 192 ml/min/m 2 (140.7-227.9) relative to healthy persons 107.9 ml/min/m 2 (69.9-138.1) (both p < 0.001). Median DO 2 I was similar in uncomplicated 515 ml/min/m 2 (432-612) and severe 487 ml/min/m 2 (382-601) malaria and healthy persons 503 ml/min/m 2 (447-517) (p = 0.27 and 0.89, respectively). The VO 2 /DO 2 ratio was, therefore, increased by similar amounts in both uncomplicated 0.35 (0.28-0.44) and severe malaria 0.38 (0.29-0.48) relative to healthy participants 0.23 (0.17-0.28) (both p < 0.001). VO 2 I, DO 2 I and VO 2 /DO 2 did not correlate with plasma lactate concentrations in severe malaria. Conclusions: Reduced total oxygen delivery is not a major contributor to lactic acidosis in severe falciparum malaria.

AB - Background: Lactic acidosis with an elevated lactate-pyruvate ratio suggesting anoxia is a common feature of severe falciparum malaria. High lactate levels are associated with parasitized erythrocyte sequestration in the microcirculation. To assess if there is an additional contribution to hyperlactataemia from relatively inadequate total oxygen delivery, oxygen consumption and delivery were investigated in patients with malaria. Methods: Adult Bangladeshi and Indian patients with uncomplicated (N = 50) or severe (N = 46) falciparum malaria or suspected bacterial sepsis (N = 27) and healthy participants as controls (N = 26) were recruited at Chittagong Medical College Hospital, Chittagong, Bangladesh and Ispat General Hospital, Rourkela, India. Oxygen delivery (DO 2 I) was estimated from pulse oximetry, echocardiographic estimates of cardiac index and haematocrit. Oxygen consumption (VO 2 I) was estimated by expired gas collection. Results: VO 2 I was elevated in uncomplicated median (IQR) 185.1 ml/min/m 2 (135-215.9) and severe malaria 192 ml/min/m 2 (140.7-227.9) relative to healthy persons 107.9 ml/min/m 2 (69.9-138.1) (both p < 0.001). Median DO 2 I was similar in uncomplicated 515 ml/min/m 2 (432-612) and severe 487 ml/min/m 2 (382-601) malaria and healthy persons 503 ml/min/m 2 (447-517) (p = 0.27 and 0.89, respectively). The VO 2 /DO 2 ratio was, therefore, increased by similar amounts in both uncomplicated 0.35 (0.28-0.44) and severe malaria 0.38 (0.29-0.48) relative to healthy participants 0.23 (0.17-0.28) (both p < 0.001). VO 2 I, DO 2 I and VO 2 /DO 2 did not correlate with plasma lactate concentrations in severe malaria. Conclusions: Reduced total oxygen delivery is not a major contributor to lactic acidosis in severe falciparum malaria.

KW - Acidosis, lactic

KW - Cardiac output

KW - Haemodynamics

KW - Malaria

KW - Microcirculation

KW - Oxygen consumption

UR - http://www.scopus.com/inward/record.url?scp=85063432536&partnerID=8YFLogxK

U2 - 10.1186/s12936-019-2733-y

DO - 10.1186/s12936-019-2733-y

M3 - Article

C2 - 30909915

AN - SCOPUS:85063432536

SN - 1475-2875

VL - 18

SP - 1

EP - 7

JO - Malaria Journal

JF - Malaria Journal

M1 - 97

ER -

Does reduced oxygen delivery cause lactic acidosis in falciparum malaria? An observational study

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