{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T23:52:27Z","timestamp":1790293947579,"version":"4.1.0"},"reference-count":29,"publisher":"Oxford University Press (OUP)","issue":"5","license":[{"start":{"date-parts":[[2021,11,12]],"date-time":"2021-11-12T00:00:00Z","timestamp":1636675200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2022,5,2]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>In imported falciparum malaria, systemic inflammation with increased capillary permeability can cause life-threatening complications, such as acute pulmonary edema (APO) or adult respiratory distress syndrome (ARDS). This observational study assessed the association of the admission serum albumin level (ALB) and C-reactive protein to albumin ratio (CRP\/ALB) with disease severity and these respiratory complications.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>All adult cases hospitalized during 2001\u20132015 in the Charit\u00e9 University Hospital, Berlin, with ALB and CRP values measured upon admission, were retrospectively analysed.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Seventy-six patients were enrolled (26 female, median age: 37 y), 60 with uncomplicated malaria and 16 with severe malaria (SM). SM was associated with lower ALB (p&amp;lt;0.0001) and higher CRP\/ALB (p&amp;lt;0.0001) values; the areas under the receiver operator curves (AUROCs) were 0.85 (95% CI 0.74 to 0.96) for ALB and 0.88 (95% CI 0.80 to 0.97) for CRP\/ALB. Radiologic changes consistent with APO\/ARDS were detectable in 5 of 45 admission chest X-rays performed (11.1%); the AUROCs were 0.86 (95% CI 0.74 to 0.99) for ALB and 0.91 (95% CI 0.82 to 0.99) for CRP\/ALB.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Diminished admission ALB levels and elevated CRP\/ALB ratios are associated with disease severity and respiratory complications in imported falciparum malaria. These readily and ubiquitously available markers may facilitate early identification of at-risk patients.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/trstmh\/trab167","type":"journal-article","created":{"date-parts":[[2021,10,24]],"date-time":"2021-10-24T03:07:28Z","timestamp":1635044848000},"page":"492-500","source":"Crossref","is-referenced-by-count":11,"title":["Elevated admission C-reactive protein to albumin ratios are associated with disease severity and respiratory complications in adults with imported falciparum malaria"],"prefix":"10.1093","volume":"116","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8277-8948","authenticated-orcid":false,"given":"Bodo","family":"Hoffmeister","sequence":"first","affiliation":[{"name":"Depart ment of Respiratory Medicine, Clinic-Group Ernst von Bergmann, Potsdam and Bad Belzig, 14806 Bad Belzig, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abner D","family":"Aguilar Valdez","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Clinic-Group Ernst von Bergmann, Potsdam and Bad Belzig, 14806 Bad Belzig, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2021,11,12]]},"reference":[{"key":"2022050515135717700_bib1","doi-asserted-by":"crossref","first-page":"972","DOI":"10.1097\/CCM.0b013e31827466d2","article-title":"Fluid resuscitation of adults with severe falciparum malaria: effects on Acid-base status, renal function, and extravascular lung water","volume":"41","author":"Hanson","year":"2013","journal-title":"Crit Care Med"},{"key":"2022050515135717700_bib2","doi-asserted-by":"crossref","first-page":"492","DOI":"10.1378\/chest.11-2655","article-title":"Respiratory manifestations of malaria","volume":"142","author":"Taylor","year":"2012","journal-title":"Chest"},{"key":"2022050515135717700_bib3","doi-asserted-by":"crossref","first-page":"e13236","DOI":"10.1371\/journal.pone.0013236","article-title":"Severe imported falciparum malaria: a cohort study in 400 critically ill Adults","volume":"5","author":"Bruneel","year":"2010","journal-title":"PLoS One"},{"key":"2022050515135717700_bib4","doi-asserted-by":"crossref","first-page":"781","DOI":"10.1016\/S0140-6736(85)91447-3","article-title":"Increased vascular permeability: a major cause of hypoalbuminaemia in disease and injury","volume":"1","author":"Fleck","year":"1985","journal-title":"Lancet"},{"issue":"Suppl 1","key":"2022050515135717700_bib5","doi-asserted-by":"crossref","first-page":"S56","DOI":"10.2215\/CJN.03090509","article-title":"Biochemistry and biomarkers of inflamed patients: why look, what to assess","volume":"4","author":"Kaysen","year":"2009","journal-title":"Clin J Am Soc Nephrol"},{"key":"2022050515135717700_bib6","doi-asserted-by":"crossref","first-page":"693","DOI":"10.1016\/S0895-4356(97)00015-2","article-title":"Association of serum albumin and mortality risk","volume":"50","author":"Goldwasser","year":"1997","journal-title":"J Clin Epidemiol"},{"key":"2022050515135717700_bib7","doi-asserted-by":"crossref","first-page":"127","DOI":"10.1053\/j.jrn.2008.08.003","article-title":"Association between serum albumin and mortality in dialysis patients is partly explained by inflammation, and not by malnutrition","volume":"19","author":"de Mutsert","year":"2009","journal-title":"J Ren Nutr"},{"key":"2022050515135717700_bib8","doi-asserted-by":"crossref","first-page":"276","DOI":"10.1016\/j.jcrc.2009.12.004","article-title":"Prognostic factors of mortality in patients with community-acquired bloodstream infection with severe sepsis and septic shock","volume":"25","author":"Artero","year":"2010","journal-title":"J Crit Care"},{"key":"2022050515135717700_bib9","doi-asserted-by":"crossref","first-page":"S1","DOI":"10.1186\/2110-5820-2-S1-S1","article-title":"Fluid management in critically ill patients: the role of extravascular lung water, abdominal hypertension, capillary leak, and fluid balance","volume":"2","author":"Cordemans","year":"2012","journal-title":"Ann Intensive Care"},{"key":"2022050515135717700_bib10","doi-asserted-by":"crossref","first-page":"14977","DOI":"10.1038\/s41598-018-33361-7","article-title":"Clinical usefulness of C-reactive protein to albumin ratio in predicting 30-day mortality in critically ill patients: a retrospective analysis","volume":"8","author":"Oh","year":"2018","journal-title":"Sci Rep"},{"key":"2022050515135717700_bib11","doi-asserted-by":"crossref","first-page":"182","DOI":"10.1007\/s00508-020-01618-9","article-title":"Presepsin:albumin ratio and C-reactive protein:albumin ratio as novel sepsis-based prognostic scores\u202f: a retrospective study","volume":"132","author":"Kaplan","year":"2020","journal-title":"Wien Klin Wochenschr"},{"key":"2022050515135717700_bib12","doi-asserted-by":"crossref","first-page":"410","DOI":"10.1186\/s12936-019-3007-4","article-title":"Hypertension is associated with an increased risk for severe imported falciparum malaria: a tertiary care hospital based observational study from Berlin, Germany","volume":"18","author":"Hoffmeister","year":"2019","journal-title":"Malar J"},{"key":"2022050515135717700_bib13","doi-asserted-by":"crossref","first-page":"1288","DOI":"10.1016\/j.jclinepi.2004.03.012","article-title":"New ICD-10 version of the Charlson comorbidity index predicted in-hospital mortality","volume":"57","author":"Sundararajan","year":"2004","journal-title":"J Clin Epidemiol"},{"key":"2022050515135717700_bib14","volume-title":"Guidelines for the treatment of malaria","author":"WHO","year":"2015","edition":"3rd ed."},{"key":"2022050515135717700_bib15","first-page":"2526","article-title":"Acute respiratory distress syndrome: the Berlin Definition","volume":"307","author":"ARDS Definition Task Force","year":"2012","journal-title":"JAMA"},{"key":"2022050515135717700_bib16","doi-asserted-by":"crossref","first-page":"1045","DOI":"10.1631\/jzus.2005.B1045","article-title":"Acute phase reaction and acute phase proteins","volume":"6","author":"Gruys","year":"2005","journal-title":"J Zhejiang Univ Sci B"},{"key":"2022050515135717700_bib17","doi-asserted-by":"crossref","first-page":"228","DOI":"10.1136\/jcp.44.3.228","article-title":"Measurement of acute phase proteins for assessing severity of Plasmodium falciparum malaria","volume":"44","author":"Gillespie","year":"1991","journal-title":"J Clin Pathol"},{"key":"2022050515135717700_bib18","doi-asserted-by":"crossref","first-page":"181","DOI":"10.1002\/jpen.1451","article-title":"Hypoalbuminemia: pathogenesis and clinical significance","volume":"43","author":"Soeters","year":"2019","journal-title":"J Parenter Enteral Nutr"},{"key":"2022050515135717700_bib19","doi-asserted-by":"crossref","first-page":"256","DOI":"10.1093\/clinids\/15.2.256","article-title":"Measures of capillary permeability in acute falciparum malaria: relation to severity of infection and treatment","volume":"15","author":"Davis","year":"1992","journal-title":"Clin Infect Dis"},{"key":"2022050515135717700_bib20","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1086\/523762","article-title":"Direct in vivo assessment of microcirculatory dysfunction in severe falciparum malaria","volume":"197","author":"Dondorp","year":"2008","journal-title":"J Infect Dis"},{"key":"2022050515135717700_bib21","doi-asserted-by":"crossref","first-page":"2693","DOI":"10.1084\/jem.20070819","article-title":"Impaired nitric oxide bioavailability and L-arginine reversible endothelial dysfunction in adults with falciparum malaria","volume":"204","author":"Yeo","year":"2007","journal-title":"J Exp Med"},{"key":"2022050515135717700_bib22","doi-asserted-by":"crossref","first-page":"282","DOI":"10.1016\/S0035-9203(02)90100-8","article-title":"The role of reduced red cell deformability in the pathogenesis of severe falciparum malaria and its restoration by blood transfusion","volume":"96","author":"Dondorp","year":"2002","journal-title":"Trans R Soc Trop Med Hyg"},{"key":"2022050515135717700_bib23","doi-asserted-by":"crossref","first-page":"507","DOI":"10.4269\/ajtmh.1997.57.507","article-title":"Prognostic significance of reduced red blood cell deformability in severe falciparum malaria","volume":"57","author":"Dondorp","year":"1997","journal-title":"Am J Trop Med Hyg"},{"key":"2022050515135717700_bib24","doi-asserted-by":"crossref","first-page":"e1268667","DOI":"10.1080\/21688370.2016.1268667","article-title":"Dynamic interactions of Plasmodium spp. with vascular endothelium","volume":"5","author":"Gillrie","year":"2017","journal-title":"Tissue Barriers"},{"key":"2022050515135717700_bib25","doi-asserted-by":"crossref","first-page":"1522","DOI":"10.1086\/644641","article-title":"Relationship of cell-free hemoglobin to impaired endothelial nitric oxide bioavailability and perfusion in severe falciparum malaria","volume":"200","author":"Yeo","year":"2009","journal-title":"J Infect Dis"},{"key":"2022050515135717700_bib26","doi-asserted-by":"crossref","first-page":"791","DOI":"10.1086\/655225","article-title":"Increased pulmonary pressures and myocardial wall stress in children with severe malaria","volume":"202","author":"Janka","year":"2010","journal-title":"J Infect Dis"},{"key":"2022050515135717700_bib27","doi-asserted-by":"crossref","first-page":"738","DOI":"10.1124\/jpet.105.086553","article-title":"Angiopoietin-2 causes inflammation in vivo by promoting vascular leakage","volume":"314","author":"Roviezzo","year":"2005","journal-title":"J Pharmacol Exp Ther"},{"key":"2022050515135717700_bib28","doi-asserted-by":"crossref","first-page":"e113","DOI":"10.1371\/journal.pmed.0030113","article-title":"Angiopoietin-2: modulator of vascular permeability in acute lung injury?","volume":"3","author":"Hashimoto","year":"2006","journal-title":"PLoS Med"},{"key":"2022050515135717700_bib29","doi-asserted-by":"crossref","first-page":"17097","DOI":"10.1073\/pnas.0805782105","article-title":"Angiopoietin-2 is associated with decreased endothelial nitric oxide and poor clinical outcome in severe falciparum malaria","volume":"105","author":"Yeo","year":"2008","journal-title":"Proc Natl Acad Sci USA"}],"container-title":["Transactions of The Royal Society of Tropical Medicine and Hygiene"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/trstmh\/article-pdf\/116\/5\/492\/43516969\/trab167.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/trstmh\/article-pdf\/116\/5\/492\/43516969\/trab167.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,5,5]],"date-time":"2022-05-05T15:14:39Z","timestamp":1651763679000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/trstmh\/article\/116\/5\/492\/6426103"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,11,12]]},"references-count":29,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2021,11,12]]},"published-print":{"date-parts":[[2022,5,2]]}},"URL":"https:\/\/doi.org\/10.1093\/trstmh\/trab167","relation":{},"ISSN":["0035-9203","1878-3503"],"issn-type":[{"value":"0035-9203","type":"print"},{"value":"1878-3503","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2022,5]]},"published":{"date-parts":[[2021,11,12]]}}}