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Clarification of factors associated with post-artesunate delayed hemolysis (PADH): analysis of 327 patients with severe imported Plasmodium falciparum malaria in France
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International audience. Background: Post-Artesunate delayed hemolysis (PADH) occurs in approximately 15 % of treated patients 2–3 weeks after artesunate administration. Identifying riskmarkers 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 assessthe 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 withpatient 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, initialhemoglobin, very severe malaria and residence in an endemic area, compared to recent African ancestry with initial parasitemia <4 %, the adjusted hazard ratio forPADH 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 Europeanswith an initial parasitemia >10 %.
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