Clinical Significance of Hypocalcaemia in Malaria: An Experience from Coastal Karnataka, India

Abstract

Introduction: Malaria is a major public health problem leading to significant morbidity and mortality in endemic regions. Malaria is a major public health problem in India, which contributes significantly to the overall malaria burden in Southeast Asia. Data on significance of hypocalcaemia in malaria is scarce. Aim: To correlate hypocalcaemia with the complications in malaria. Materials and Methods: This cross-sectional, observational study was conducted at Father Muller Medical College in Coastal Karnataka between January 2018 to June 2019. Patients diagnosed as malaria by peripheral smear were included. Serum calcium level was measured in all the patients and calcium levels <8.4 mg/dL was considered as hypocalcaemia. This was correlated with the complications such as jaundice, acute kidney injury, cerebral malaria, shock, multiorgan dysfunction and Acute Respiratory Distress Syndrome (ARDS) in malaria. Data were analysed using frequency, percentages, Chi-square test, student t-test, relative risk estimation and Receiver operating Characteristic (ROC) analysis. Results: A total of seventy five patients with malaria were included in the study. Majority were in the age group of 21-30 years (30.6%), with a male predominance (53 patients, 70.67%). Among these patients, complications were documented in 18 (24%) of them. Hypocalcaemia was seen in 25 patients (33.3%) among whom 13 (52%) had complications. The association of hypocalcaemia with the complications was statistically highly significant (p=0.001). Patients with hypocalcaemia had a relative risk of 9.75% (2.901-32.766, 95% CI) for developing complications. With ROC analysis, the calcium value cut-off for complications was 8.25 with a sensitivity of 72% and specificity of 86%. Calcium reverted to normal in all patients after recovery from complications. Conclusion: Hypocalcaemia had a significant association with high specificity for complications in malaria.