Clarification of factors associated with post-artesunate delayed hemolysis (PADH): Analysis of 327 patients with severe imported Plasmodium falciparum malaria in France
Background: Post-Artesunate delayed hemolysis (PADH) occurs in approximately 15 % of treated patients 2–3 weeks after artesunate administration. Identifying risk markers for PADH would help predict which patients are at higher risk. Methods: In this prospective national cohort study conducted in a n...
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Elsevier
2025-03-01
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| Series: | Travel Medicine and Infectious Disease |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S1477893925000079 |
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| author | Pierre-Louis Conan Marc Thellier Eric Kendjo Sandrine Houzé Rémonie Seng Stéphane Jauréguiberry |
| author_facet | Pierre-Louis Conan Marc Thellier Eric Kendjo Sandrine Houzé Rémonie Seng Stéphane Jauréguiberry |
| author_sort | Pierre-Louis Conan |
| collection | DOAJ |
| description | Background: Post-Artesunate delayed hemolysis (PADH) occurs in approximately 15 % of treated patients 2–3 weeks after artesunate administration. Identifying risk markers for PADH would help predict which patients are at higher risk. Methods: In this prospective national cohort study conducted in a non-malaria endemic area from 2011 to 2016, a Cox proportional hazards model was used to assess the association between clinical and biological data available at Day 0 and the occurrence of PADH within 30 days of artesunate administration. Results: In the analyzed population (n = 327), 49 PADH events occurred after a median time of14 days (IQR, 13–17) after artesunate initiation. Higher initial parasitemia was associated with an increased risk of PADH, with a significant interaction found with patient origin. The cumulative probability of PADH event at Day 30 post-artesunate was 65 % (95 % confidence interval [CI], 44–79) for European patients vs. 14 % (95 % CI, 0–26) for those with recent African ancestry [RAA] when the initial parasitemia was >10 %. After adjustment for weight, history of malaria, initial hemoglobin, very severe malaria and residence in an endemic area, compared to recent African ancestry with initial parasitemia <4 %, the adjusted hazard ratio for PADH occurrence was 18.8 (95 % CI, 4–89) for Europeans and 4.77 (95 % CI, 0.8–29.2) for recent African ancestry with initial parasitemia >10 %. Conclusions: This study showed that initial parasitemia and patient origin were the main predictors of developing PADH, with the highest risk observed in Europeans with an initial parasitemia >10 %. |
| format | Article |
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| institution | Kabale University |
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| language | English |
| publishDate | 2025-03-01 |
| publisher | Elsevier |
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| series | Travel Medicine and Infectious Disease |
| spelling | doaj-art-350153c8380a4c44ba966bd95776015a2025-02-02T05:26:57ZengElsevierTravel Medicine and Infectious Disease1873-04422025-03-0164102801Clarification of factors associated with post-artesunate delayed hemolysis (PADH): Analysis of 327 patients with severe imported Plasmodium falciparum malaria in FrancePierre-Louis Conan0Marc Thellier1Eric Kendjo2Sandrine Houzé3Rémonie Seng4Stéphane Jauréguiberry5Service des Maladies Infectieuses et Tropicales, Hôpital d’Instruction des Armées Bégin, Saint-Mandé, France; Corresponding author. Service de maladies infectieuses et tropicales, Hôpital d’Instruction des Armées Bégin, 69 avenue de Paris, 94160, Saint-Mandé, France.Sorbonne Université, Institut Pierre Louis d’Epidémiologie et de Santé publique, Inserm, Paris, France; Centre National de Référence du Paludisme, Paris, France; Sorbonne Université, Service de Parasitologie, Hôpital Pitié-Salpétrière, APHP, Paris, FranceSorbonne Université, Institut Pierre Louis d’Epidémiologie et de Santé publique, Inserm, Paris, France; Centre National de Référence du Paludisme, Paris, FranceCentre National de Référence du Paludisme, Paris, France; Université Paris-Cité, IRD, MERIT, Paris, FranceCentre de Recherche en Epidémiologie et Santé des Populations (CESP), INSERM, U1018, Paris, France; Service de Sante Publique et d’Epidémiologie, AP-HP, Hôpital Bicêtre, Le Kremlin-Bicêtre, FranceCentre National de Référence du Paludisme, Paris, France; Centre de Recherche en Epidémiologie et Santé des Populations (CESP), INSERM, U1018, Paris, France; Université Paris-Saclay, Service des Maladies Infectieuses et Tropicales, APHP, Hôpital Bicêtre, Le Kremlin-Bicêtre, France; Société Française de Médecine des Voyages, FranceBackground: Post-Artesunate delayed hemolysis (PADH) occurs in approximately 15 % of treated patients 2–3 weeks after artesunate administration. Identifying risk markers for PADH would help predict which patients are at higher risk. Methods: In this prospective national cohort study conducted in a non-malaria endemic area from 2011 to 2016, a Cox proportional hazards model was used to assess the association between clinical and biological data available at Day 0 and the occurrence of PADH within 30 days of artesunate administration. Results: In the analyzed population (n = 327), 49 PADH events occurred after a median time of14 days (IQR, 13–17) after artesunate initiation. Higher initial parasitemia was associated with an increased risk of PADH, with a significant interaction found with patient origin. The cumulative probability of PADH event at Day 30 post-artesunate was 65 % (95 % confidence interval [CI], 44–79) for European patients vs. 14 % (95 % CI, 0–26) for those with recent African ancestry [RAA] when the initial parasitemia was >10 %. After adjustment for weight, history of malaria, initial hemoglobin, very severe malaria and residence in an endemic area, compared to recent African ancestry with initial parasitemia <4 %, the adjusted hazard ratio for PADH occurrence was 18.8 (95 % CI, 4–89) for Europeans and 4.77 (95 % CI, 0.8–29.2) for recent African ancestry with initial parasitemia >10 %. Conclusions: This study showed that initial parasitemia and patient origin were the main predictors of developing PADH, with the highest risk observed in Europeans with an initial parasitemia >10 %.http://www.sciencedirect.com/science/article/pii/S1477893925000079 |
| spellingShingle | Pierre-Louis Conan Marc Thellier Eric Kendjo Sandrine Houzé Rémonie Seng Stéphane Jauréguiberry Clarification of factors associated with post-artesunate delayed hemolysis (PADH): Analysis of 327 patients with severe imported Plasmodium falciparum malaria in France Travel Medicine and Infectious Disease |
| title | Clarification of factors associated with post-artesunate delayed hemolysis (PADH): Analysis of 327 patients with severe imported Plasmodium falciparum malaria in France |
| title_full | Clarification of factors associated with post-artesunate delayed hemolysis (PADH): Analysis of 327 patients with severe imported Plasmodium falciparum malaria in France |
| title_fullStr | Clarification of factors associated with post-artesunate delayed hemolysis (PADH): Analysis of 327 patients with severe imported Plasmodium falciparum malaria in France |
| title_full_unstemmed | Clarification of factors associated with post-artesunate delayed hemolysis (PADH): Analysis of 327 patients with severe imported Plasmodium falciparum malaria in France |
| title_short | Clarification of factors associated with post-artesunate delayed hemolysis (PADH): Analysis of 327 patients with severe imported Plasmodium falciparum malaria in France |
| title_sort | clarification of factors associated with post artesunate delayed hemolysis padh analysis of 327 patients with severe imported plasmodium falciparum malaria in france |
| url | http://www.sciencedirect.com/science/article/pii/S1477893925000079 |
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