A Study of Uric Acid Level as a Marker of Severity in Malaria

Context: Malaria is an inflammatory condition triggered by the infection of parasite Plasmodium on erythrocytes. It is characterised by periodic fever with chills due to rupture of erythrocytes to release the progeny parasites. It is marked by release of variety of cytokines like IL-6, IL-12, IFN-Ɣ, TNF—α etc. Uric acid is one of the emerging inflammatory markers in malaria that demands attention. One of the proposed mechanisms is that there is accumulation of uric acid and its precursor, hypoxanthine in the infected erythrocytes. These are released into the blood on rupture of the schizont.  Aim: To find association of serum uric acid level with severity of malaria.Settings and Design: This was a hospital based longitudinal study conducted at a tertiary care centre in Kolkata, India. Materials and Methods: We measured the plasma levels of uric acid and various inflammatory markers {Ferritin, C-reactive protein(CRP), LDH, C3, C4} in eighty eight  patients admitted with microscopically proven malaria (severe or non-severe type). The levels of uric acid were compared with the disease severity and the inflammatory markers stated above. Statistical Analysis used: The data was analyzed using MedCalc software and Microsoft Excel 2010 and further graphically plotted. Results: The serum uric acid levels were raised in 18.51% of patients with severe malaria compared to only 4.91% with non-severe variety (p= 0.04). The uric acid levels demonstrated a positive correlation with CRP (r=0.3334, p=0.0015); procalcitonin & ferritn (r=0.3701, p<0.0005). However, it was negatively correlated with C3 (r= -0.3780, p= 0.0003) and C4 (r=0.3180, p<0.005). A univariate regression analysis supported our results to establish the correlation. However, multiple logistic regression analysis demonstrated significant association between serum uric acid levels on day 1 and C3 decrement as a marker of disease severity.  Conclusion:  Thus, it can be concluded that there is a definite association between the severity of malaria and plasma uric acid levels. Although, this study does not establish the causation, it acts as a cornerstone for further research into this field.