Malarial hepatopathy: a 6-year retrospective observational study from Uttarakhand, North India.

Background: Jaundice in malaria is multifactorial. Plasmodium falciparum causes malarial hepatopathy in around 2.5% of cases. The spectrum of hepatic dysfunction in patients with malaria varies from mild clinical and biochemical abnormalities to fulminant hepatic failure, although hepatic encephalopathy almost never occurs. We undertook this study in order to estimate the magnitude of hepatopathy in malaria, and study the associated clinical features, complications and outcome of patients.

Methods: We retrospectively analyzed the data of patients with acute malaria hospitalized from between 2009 and 2015. We compared the clinical features, demographic parameters, laboratory findings, complications and outcome of patients with and without hepatopathy.

Results: Hepatopathy was observed in 22% (215/978) (n=215) of those with acute malaria (n=978) due to mono-infection by Plasmodium vivax (56.7%) or P. falciparum (38.1%) and their co-infection (5.1%). The age of the patients ranged from 2 to 96 years, with male preponderance (63.2%). Bleeding events, thrombocytopenia, total leukocyte count, levels of transaminases (aspartate transaminases, alanine transaminases), serum bilirubin, serum albumin and serum creatinine, duration of hospitalization and mortality were significantly greater in patients with malarial hepatopathy (p<0.05). Also, hepatopathy and renal dysfunction were significantly associated (OR 5.35; p<0.001).

Conclusion: Hepatopathy is a serious complication of malaria, and is associated with other organ dysfunction and greater mortality.