ArticleJournal of thrombosis and haemostasis : JTH2015
Laboratory evidence of disseminated intravascular coagulation is associated with a fatal outcome in children with cerebral malaria despite an absence of clinically evident thrombosis or bleeding.
Article in Journal of thrombosis and haemostasis : JTH, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 29 papers, 1 of them a synthesis that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
29 citing papers in PubMed, 1 synthesis or guideline pooled it, 42 citations in OpenAlex.
- Alteration of prothrombin time in Plasmodium falciparum and Plasmodium vivax infections with different levels of severity: a systematic review and meta-analysis.Scientific reports · 2024Pooled it
- Alterations of blood coagulation in controlled human malaria infection.Malaria journal · 2016Trial
- CCL5 and CD11b-fibrin interactions regulate microglia migration and morphology in hyperinflammatory experimental cerebral malaria.Journal of neuroinflammation · 2026Article
- Anticoagulant therapy and altered tissue factor expression protect against experimental placental and cerebral malaria.PLoS pathogens · 2025Article
- Infection with Toxoplasma gondii triggers coagulation at the blood-brain barrier and a reduction in cerebral blood flow.Journal of neuroinflammation · 2025Article
- An Assessment of Endothelial Markers in Patients with Uncomplicated Malaria in Jazan Province, Saudi Arabia.International journal of general medicine · 2025Article
- Basic coagulation parameters and platelet count among malaria patients attending at Addis Zemen Primary Hospital, Northwest Ethiopia.BMC infectious diseases · 2024Article
- Exploring coagulation parameters as predictive biomarkers of Plasmodium infection: A comprehensive analysis of coagulation parameters.PloS one · 2024Article
- A Systematic Review and Meta-Analysis of the Proportion Estimates of Disseminated Intravascular Coagulation (DIC) in Malaria.Tropical medicine and infectious disease · 2023Review
- Diagnosis of cerebral malaria: Tools to reduceFrontiers in cellular and infection microbiology · 2023Review
- Elevated Levels of Procoagulant Microvesicles and Tissue-Factor Bearing Microvesicles in Malaria Patients.International journal of general medicine · 2023Article
- Hemostatic and protein C pathway dysfunction in the pathogenesis of experimental cerebral malaria.Haematologica · 2022Article
- Histological Identification of Sequestered Parasitized Red Cells.Methods in molecular biology (Clifton, N.J.) · 2022Article
- Article
- Parasite histones are toxic to brain endothelium and link blood barrier breakdown and thrombosis in cerebral malaria.Blood advances · 2020Article
- Plasma cell-free DNA predicts pediatric cerebral malaria severity.JCI insight · 2020Article
- Testing the effect of PAR1 inhibitors onWellcome open research · 2020Article
- Interplay of Plasmodium falciparum and thrombin in brain endothelial barrier disruption.Scientific reports · 2019Article
- Cerebral malaria is associated with differential cytoadherence to brain endothelial cells.EMBO molecular medicine · 2019Article
- Opportunities for Host-targeted Therapies for Malaria.Trends in parasitology · 2018Review
Corrections and comments
- Erratum issuedErratum.2016
Authors and funding
11 authors at 5 institutions in 3 countries.
Funding
Abstract
backgroundA procoagulant state is implicated in cerebral malaria (CM) pathogenesis, but whether disseminated intravascular coagulation (DIC) is present or associated with a fatal outcome is unclear.
objectivesTo determine the frequency of overt DIC, according to ISTH criteria, in children with fatal and non-fatal CM. METHODS/PATIENTS: Malawian children were recruited into a prospective cohort study in the following diagnostic groups: retinopathy-positive CM (n = 140), retinopathy-negative CM (n = 36), non-malarial coma (n = 14), uncomplicated malaria (UM), (n = 91), mild non-malarial febrile illness (n = 85), and healthy controls (n = 36). Assays in the ISTH DIC criteria were performed, and three fibrin-related markers, i.e. protein C, antithrombin, and soluble thrombomodulin, were measured. RESULTS AND
conclusionsData enabling assignment of the presence or absence of 'overt DIC' were available for 98 of 140 children with retinopathy-positive CM. Overt DIC was present in 19 (19%), and was associated with a fatal outcome (odds ratio [OR] 3.068; 95% confidence interval [CI] 1.085-8.609; P = 0.035]. The levels of the three fibrin-related markers and soluble thrombomodulin were higher in CM patients than in UM patients (all P < 0.001). The mean fibrin degradation product level was higher in fatal CM patients (71.3 μg mL(-1) [95% CI 49.0-93.6]) than in non-fatal CM patients (48.0 μg mL(-1) [95% CI 37.7-58.2]; P = 0.032), but, in multivariate logistic regression, thrombomodulin was the only coagulation-related marker that was independently associated with a fatal outcome (OR 1.084 for each ng mL(-1) increase [95% CI 1.017-1.156]; P = 0.014). Despite these laboratory derangements, no child in the study had clinically evident bleeding or thrombosis. An overt DIC score and high thrombomodulin levels are associated with a fatal outcome in CM, but infrequently indicate a consumptive coagulopathy.
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