Increased Carboxyhemoglobin in Adult Falciparum Malaria is Associated With Disease Severity and Mortality

Tsin Yeo, Daniel Lampah, Enny Kenangalem, Emiliana Tjitra, Ric Price, Nicholas Anstey

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Heme oxygenase 1 expression is increased in pediatric patients with malaria. The carboxyhemoglobin level (a measure of heme oxygenase 1 activity) has not been assessed in adult patients with malaria. Results of pulse co-oximetry revealed that the mean carboxyhemoglobin level was elevated in 29 Indonesian adults with severe falciparum malaria (10%; 95% confidence interval [CI], 8%-13%) and in 20 with severe sepsis (8%; 95% CI, 5%-12%), compared with the mean levels in 32 patients with moderately severe malaria (7%; 95% CI, 5%-8%) and 36 controls (3.6%; 95% CI, 3%-5%; P <. 001). An increased carboxyhemoglobin level was associated with an increased odds of death among patients with severe malaria (odds ratio, 1.2 per percentage point increase; 95% CI, 1.02-1.5). While also associated with severity and fatality, methemoglobin was only modestly increased in patients with severe malaria. Increased carboxyhemoglobin levels during severe malaria and sepsis may exacerbate organ dysfunction by reducing oxygen carriage and cautions against the use of adjunctive CO therapy, which was proposed on the basis of mouse models. � 2013 The Author.
Original languageEnglish
Pages (from-to)813-817
Number of pages5
JournalJournal of Infectious Diseases
Volume208
Issue number5
DOIs
Publication statusPublished - Sep 2013

Fingerprint

Carboxyhemoglobin
Falciparum Malaria
Malaria
Confidence Intervals
Mortality
Heme Oxygenase-1
Sepsis
Methemoglobin
Oximetry
Carbon Monoxide
Odds Ratio
Pediatrics
Oxygen

Cite this

@article{6366c22c944542caaa0bd0959cc9a7ee,
title = "Increased Carboxyhemoglobin in Adult Falciparum Malaria is Associated With Disease Severity and Mortality",
abstract = "Heme oxygenase 1 expression is increased in pediatric patients with malaria. The carboxyhemoglobin level (a measure of heme oxygenase 1 activity) has not been assessed in adult patients with malaria. Results of pulse co-oximetry revealed that the mean carboxyhemoglobin level was elevated in 29 Indonesian adults with severe falciparum malaria (10{\%}; 95{\%} confidence interval [CI], 8{\%}-13{\%}) and in 20 with severe sepsis (8{\%}; 95{\%} CI, 5{\%}-12{\%}), compared with the mean levels in 32 patients with moderately severe malaria (7{\%}; 95{\%} CI, 5{\%}-8{\%}) and 36 controls (3.6{\%}; 95{\%} CI, 3{\%}-5{\%}; P <. 001). An increased carboxyhemoglobin level was associated with an increased odds of death among patients with severe malaria (odds ratio, 1.2 per percentage point increase; 95{\%} CI, 1.02-1.5). While also associated with severity and fatality, methemoglobin was only modestly increased in patients with severe malaria. Increased carboxyhemoglobin levels during severe malaria and sepsis may exacerbate organ dysfunction by reducing oxygen carriage and cautions against the use of adjunctive CO therapy, which was proposed on the basis of mouse models. � 2013 The Author.",
keywords = "carboxyhemoglobin, heme oxygenase 1, methemoglobin, adult, article, clinical article, controlled study, disease association, disease severity, female, hemoglobin determination, human, malaria falciparum, male, mortality, priority journal, pulse oximetry, sepsis, Plasmodium falciparum, Severe malaria, Adolescent, Adult, Animals, Biological Markers, Carboxyhemoglobin, Female, Humans, Indonesia, Malaria, Falciparum, Male, Mice, Middle Aged, Severity of Illness Index, Survival Analysis, Young Adult",
author = "Tsin Yeo and Daniel Lampah and Enny Kenangalem and Emiliana Tjitra and Ric Price and Nicholas Anstey",
year = "2013",
month = "9",
doi = "10.1093/infdis/jit253",
language = "English",
volume = "208",
pages = "813--817",
journal = "Journal of Infectious Diseases",
issn = "0022-1899",
publisher = "Oxford University Press",
number = "5",

}

Increased Carboxyhemoglobin in Adult Falciparum Malaria is Associated With Disease Severity and Mortality. / Yeo, Tsin; Lampah, Daniel; Kenangalem, Enny; Tjitra, Emiliana; Price, Ric; Anstey, Nicholas.

In: Journal of Infectious Diseases, Vol. 208, No. 5, 09.2013, p. 813-817.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Increased Carboxyhemoglobin in Adult Falciparum Malaria is Associated With Disease Severity and Mortality

AU - Yeo, Tsin

AU - Lampah, Daniel

AU - Kenangalem, Enny

AU - Tjitra, Emiliana

AU - Price, Ric

AU - Anstey, Nicholas

PY - 2013/9

Y1 - 2013/9

N2 - Heme oxygenase 1 expression is increased in pediatric patients with malaria. The carboxyhemoglobin level (a measure of heme oxygenase 1 activity) has not been assessed in adult patients with malaria. Results of pulse co-oximetry revealed that the mean carboxyhemoglobin level was elevated in 29 Indonesian adults with severe falciparum malaria (10%; 95% confidence interval [CI], 8%-13%) and in 20 with severe sepsis (8%; 95% CI, 5%-12%), compared with the mean levels in 32 patients with moderately severe malaria (7%; 95% CI, 5%-8%) and 36 controls (3.6%; 95% CI, 3%-5%; P <. 001). An increased carboxyhemoglobin level was associated with an increased odds of death among patients with severe malaria (odds ratio, 1.2 per percentage point increase; 95% CI, 1.02-1.5). While also associated with severity and fatality, methemoglobin was only modestly increased in patients with severe malaria. Increased carboxyhemoglobin levels during severe malaria and sepsis may exacerbate organ dysfunction by reducing oxygen carriage and cautions against the use of adjunctive CO therapy, which was proposed on the basis of mouse models. � 2013 The Author.

AB - Heme oxygenase 1 expression is increased in pediatric patients with malaria. The carboxyhemoglobin level (a measure of heme oxygenase 1 activity) has not been assessed in adult patients with malaria. Results of pulse co-oximetry revealed that the mean carboxyhemoglobin level was elevated in 29 Indonesian adults with severe falciparum malaria (10%; 95% confidence interval [CI], 8%-13%) and in 20 with severe sepsis (8%; 95% CI, 5%-12%), compared with the mean levels in 32 patients with moderately severe malaria (7%; 95% CI, 5%-8%) and 36 controls (3.6%; 95% CI, 3%-5%; P <. 001). An increased carboxyhemoglobin level was associated with an increased odds of death among patients with severe malaria (odds ratio, 1.2 per percentage point increase; 95% CI, 1.02-1.5). While also associated with severity and fatality, methemoglobin was only modestly increased in patients with severe malaria. Increased carboxyhemoglobin levels during severe malaria and sepsis may exacerbate organ dysfunction by reducing oxygen carriage and cautions against the use of adjunctive CO therapy, which was proposed on the basis of mouse models. � 2013 The Author.

KW - carboxyhemoglobin

KW - heme oxygenase 1

KW - methemoglobin

KW - adult

KW - article

KW - clinical article

KW - controlled study

KW - disease association

KW - disease severity

KW - female

KW - hemoglobin determination

KW - human

KW - malaria falciparum

KW - male

KW - mortality

KW - priority journal

KW - pulse oximetry

KW - sepsis

KW - Plasmodium falciparum

KW - Severe malaria

KW - Adolescent

KW - Adult

KW - Animals

KW - Biological Markers

KW - Carboxyhemoglobin

KW - Female

KW - Humans

KW - Indonesia

KW - Malaria, Falciparum

KW - Male

KW - Mice

KW - Middle Aged

KW - Severity of Illness Index

KW - Survival Analysis

KW - Young Adult

UR - http://www.scopus.com/inward/record.url?scp=84881631940&partnerID=8YFLogxK

U2 - 10.1093/infdis/jit253

DO - 10.1093/infdis/jit253

M3 - Article

VL - 208

SP - 813

EP - 817

JO - Journal of Infectious Diseases

JF - Journal of Infectious Diseases

SN - 0022-1899

IS - 5

ER -