Haematologic and Biochemical Parameters to Differentiate Severe Malaria from Uncomplicated Malaria in a Ghanaian Population in Sub-Saharan Africa

Abstract

Malaria is classified as either uncomplicated (UM) or severe (SM), but the mechanism underlying the progression from uncomplicated to severe is still unclear. This study aimed to assess haematologic and biochemical parameters as potential prognostic biomarkers for differentiating SM from UM in a Ghanaian population. A descriptive cross-sectional study was conducted to sample 166 participants, comprising 42 healthy controls, 78 uncomplicated malaria cases, and 46 severe malaria cases. Blood samples were analysed for full blood count, liver function test, renal function test, and serum angiopoietins. Statistical analyses were carried out using GraphPad Prism 9 software. Median and interquartile ranges, Mann-Whitney U test, and Kruskal-Wallis analysis were done to compare groups. The haemoglobin and platelet counts of SM patients were significantly lower than those of the UM group (p < 0.05). However, the White Blood Cell (WBC) counts of severe malaria patients (7.4, IQR: 5.4 - 10.6) were significantly higher than the uncomplicated malaria population (5.7, IQR: 5.0 - 6.5) (p < 0.001). Serum levels of bilirubin (total and direct), alanine transaminase (ALT), aspartate transaminase (AST), gamma-glutamyl transferase (GGT), alkaline phosphatase (ALP), and total proteins in severe malaria were significantly higher than uncomplicated malaria group (p < 0.001). These findings indicate that haemoglobin, platelet, creatinine, urea, AST, ALT, GGT and bilirubin levels may serve as biomarkers for distinguishing severe from uncomplicated malaria.