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Meta-Analysis
. 2024 May 2;14(1):9816.
doi: 10.1038/s41598-024-60170-y.

Alteration of prothrombin time in Plasmodium falciparum and Plasmodium vivax infections with different levels of severity: a systematic review and meta-analysis

Suriyan Sukati  1   2 , Tirawat Wannatung  3 , Thitinat Duangchan  1   2 , Kwuntida Uthaisar Kotepui  4 , Frederick Ramirez Masangkay  5 , Ching-Ping Tseng  6   7   8 , Manas Kotepui  9
Affiliations
Meta-Analysis

Alteration of prothrombin time in Plasmodium falciparum and Plasmodium vivax infections with different levels of severity: a systematic review and meta-analysis

Suriyan Sukati et al. Sci Rep. .

Abstract

Malaria infection leads to hematological abnormalities, including deranged prothrombin time (PT). Given the inconsistent findings regarding PT in malaria across different severities and between Plasmodium falciparum and P. vivax, this study aimed to synthesize available evidence on PT variations in clinical malaria. A systematic literature search was performed in PubMed, Embase, Scopus, Ovid, and Medline from 27 November 2021 to 2 March 2023 to obtain studies documenting PT in malaria. Study quality was evaluated using the Joanna Briggs Institute checklist, with data synthesized through both qualitative and quantitative methods, including meta-regression and subgroup analyses, to explore heterogeneity and publication bias. From 2767 articles, 21 studies were included. Most studies reported prolonged or increased PT in malaria patients compared to controls, a finding substantiated by the meta-analysis (P < 0.01, Mean difference: 8.86 s, 95% CI 5.32-12.40 s, I2: 87.88%, 4 studies). Severe malaria cases also showed significantly higher PT than non-severe ones (P = 0.03, Hedges's g: 1.65, 95% CI 0.20-3.10, I2: 97.91%, 7 studies). No significant PT difference was observed between P. falciparum and P. vivax infections (P = 0.88, Mean difference: 0.06, 95% CI - 0.691-0.8, I2: 65.09%, 2 studies). The relationship between PT and malaria-related mortality remains unclear, underscoring the need for further studies. PT is typically prolonged or increased in malaria, particularly in severe cases, with no notable difference between P. falciparum and P. vivax infections. The inconsistency in PT findings between fatal and non-fatal cases highlights a gap in current understanding, emphasizing the need for future studies to inform therapeutic strategies.

Keywords: Plasmodium; Coagulation; Malaria; PT; Prothrombin time; Severity.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Figure 1
Figure 1
Study flow diagram showing the study selection processes.
Figure 2
Figure 2
The meta-analysis using the data from four studies showed significantly higher PT (unit in second) in malaria patients compared to uninfected controls. Abbreviations: N, number of participants; CI, confidence interval; SD, standard deviation.
Figure 3
Figure 3
The meta-analysis using the data from seven studies showed significantly higher PT (unit in second) in severe malaria than non-severe malaria. Abbreviations: N, number of participants; CI, confidence interval; SD, standard deviation.
Figure 4
Figure 4
The leave-one-out meta-analysis of PT (unit in second) between malaria patients and uninfected controls showed no study outlier that affect the pooled effect estimate. Abbreviations: CI, confidence interval.
Figure 5
Figure 5
The leave-one-out meta-analysis of PT (unit in second) between severe and non-severe malaria showed study outliers that affect the pooled effect estimate. Abbreviations: CI, confidence interval.
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