D-dimer levels in non-immune travelers with malaria

Background: Elevated serum D-dimer levels may reflect endothelial activation, which in malaria may correlate with parasite biomass and disease severity. Methods: We performed a retrospective chart review of all non-immune travelers hospitalized with malaria during 01/2000-12/2014 M the Sheba Medical Center, Israel. Admission and peak D-dimer levels were compared among malaria patients, according to Plasmodium species and severity. Results: Complete laboratory data was available for 94/168 travelers hospitalized with malaria, with 68.1% caused by P. falciparum. Admission D-dimer levels were significantly higher in P. falciparum malaria compared to non falciparum malaria cases (3585 +/- 7045 and 802 +/- 1248 ng/dL respectively, p = 0.04). Admission D-dimer levels were higher in patients with severe compared to non-severe P. falciparum malaria (4058 +/- 3544 & 3490 +/- 7549 ng/dL), however the difference was short of statistical significance (P = 0.06). Peak D-dimer levels were also significantly higher in severe and non-severe P. falciparum than in non falciparum cases. Conclusions: In most non-immune travelers with malaria, D-dimer levels are elevated, are higher in P. falciparum malaria compared to non falciparum malaria, and appear to increase with disease severity, probably reflecting the level of endothelial damage.