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Please use this identifier to cite or link to this item: http://repository.li.mahidol.ac.th/dspace/handle/123456789/49671
Title: Cell-Free Hemoglobin Is Associated With Increased Vascular Resistance and Reduced Peripheral Perfusion in Severe Malaria
Authors: Hugh W.F. Kingston
Aniruddha Ghose
Voravut Rungpradubvong
Sudarat Satitthummanid
M. Trent Herdman
Katherine Plewes
Haruhiko Ishioka
Stije J. Leopold
Ipsita Sinha
Benjamas Intharabut
Kim Piera
Yvette McNeil
Sanjib Mohanty
Richard J. Maude
Nicholas J. White
Nicholas P.J. Day
Tsin W. Yeo
Md Amir Hossain
Nicholas M. Anstey
Arjen M. Dondorp
Ispat General Hospital
Chulalongkorn University
Menzies School of Health Research
King Chulalongkorn Memorial Hospital, Faculty of Medicine Chulalongkorn University
Churchill Hospital
Mahidol University
Chittagong Medical College
Nanyang Technological University
Tan Tock Seng Hospital
Keywords: Medicine
Issue Date: 1-Jan-2020
Citation: The Journal of infectious diseases. Vol.221, No.1 (2020), 127-137
Abstract: © The Author(s) 2019. Published by Oxford University Press for the Infectious Diseases Society of America. BACKGROUND: In severe falciparum malaria, unlike sepsis, hypotension on admission is uncommon. We hypothesized that low nitric oxide bioavailability due to the presence of cell-free hemoglobin (CFH) increases vascular tone in severe malaria. METHODS: Patients with severe malaria (n = 119), uncomplicated malaria (n = 91), or suspected bacterial sepsis (n = 56), as well as healthy participants (n = 50), were recruited. The systemic vascular resistance index (SVRI) was estimated from the echocardiographic cardiac index and the mean arterial pressure. RESULTS: SVRI and hematocrit levels were lower and plasma CFH and asymmetric dimethylarginine levels were higher in patients with malaria, compared with healthy participants. In multivariate linear regression models for mean arterial pressure or SVRI in patients with severe malaria, hematocrit and CFH but not asymmetric dimethylarginine were significant predictors. The SVRI was lower in patients with suspected bacterial sepsis than in those with severe malaria, after adjustment for hematocrit and age. Plasma CFH levels correlated positively with the core-peripheral temperature gradient and plasma lactate levels and inversely with the perfusion index. Impaired peripheral perfusion, as reflected by a low perfusion index or a high core-peripheral temperature gradient, predicted mortality in patients with severe malaria. CONCLUSIONS: CFH is associated with mean arterial pressure, SVRI, and peripheral perfusion in patients with severe malaria. This may be mediated through the nitric oxide scavenging potency of CFH, increasing basal vascular tone and impairing tissue perfusion.
URI: http://repository.li.mahidol.ac.th/dspace/handle/123456789/49671
metadata.dc.identifier.url: https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85076505939&origin=inward
ISSN: 15376613
Appears in Collections:Scopus 2020

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