Impact of Malaria Infection on the Diagnostic Performance of Adipsin for Preeclampsia in Pregnancy: A Case-Control Study.

BACKGROUND

Malaria and preeclampsia are major pregnancy-related complications that share overlapping complement and inflammation-mediated pathways. Although adipsin has been proposed as a diagnostic biomarker for preeclampsia, its diagnostic performance in the context of concurrent malaria infection remains poorly understood. This study investigated the impact of malaria infection on plasma adipsin levels and evaluated its diagnostic performance for preeclampsia.

METHODS

This case-control study included 200 pregnant women between 20 and 42 weeks of gestation, stratified into four groups: normotensive without malaria, normotensive with malaria, preeclamptic with malaria, and preeclamptic without malaria (n = 50 per group). Plasma adipsin, C3a, C5a, TNF-α, IL-6, IL-8 and IFN-γ were measured using commercial ELISA kits. Malaria infection was confirmed with Giemsa-stained blood smears. Data were analysed using Statistical Package for the Social Sciences (SPSS) Version 27.0.

RESULTS

Amongst the participants enrolled, malaria infection was present in 50% and preeclampsia in 50% of the sample. Plasma adipsin levels were significantly elevated in malaria-infected and preeclamptic participants (p < 0.001), with the highest concentrations observed in participants with coexisting preeclampsia and malaria infection. Plasma adipsin showed strong positive correlations with C5a (ρ = 0.695), IL-6 (ρ = 0.687), and TNF-α (ρ = 0.645), and moderate correlations with malaria parasite density (ρ = 0.553), IL-8 (ρ = 0.475) and C3a (ρ = 0.437) (p < 0.001 for all). Multivariable regression showed that preeclampsia and malaria independently elevated plasma adipsin levels, with a significant negative interaction between the two conditions (p < 0.001). ROC analysis showed reduced diagnostic specificity for preeclampsia in malaria-infected participants (62.1%, AUC = 0.719, p = 0.02) compared with malaria-negative participants (87.9%, AUC = 0.823, p < 0.001).

CONCLUSION

Plasmodium falciparum infection significantly alters plasma adipsin levels, reducing its diagnostic specificity for preeclampsia. Malaria-adjusted reference thresholds may be necessary when considering adipsin as a biomarker in endemic regions.