关键词: 疟疾, 急性肾损伤, 中国海外劳工, 危险因素, 公共卫生

Abstract:

Objective To analyze the epidemiological characteristics and primary clinical features of malaria-associated acute kidney injury (MAKI) in adults in Franceville, Gabon, thus providing evidence for the prevention and control of malaria complications among Chinese overseas workers. Methods A retrospective analysis was conducted on 1, 185 adult patients with Plasmodium falciparum (P. falciparum) malaria admitted to the Sino-Gabonese Friendship Hospital in Gabon between November 2023 and October 2024. The incidence of MAKI and the number of patients per month were calculated. Logistic regression analysis was used to identify significant clinical features associated with MAKI. Results A total of 127 MAKI cases were identified, with an incidence of 10.72%. The incidence of MAKI showed a strong positive correlation with the seasonal distribution of P. falciparum infections (r=0.94, P<0.01). MAKI patients had a mean age of (41.26±7.63) years, and 87 (68.50%) were male. Their mean body mass index (BMI) was (27.31±4.75) kg/m², and 94 patients (74.02%) reported urinary abnormalities. Laboratory findings included a mean red blood cell count of (4.27±0.74)×10¹²/L and hemoglobin level of (42.98±13.96) g/L. Logistic regression identified the following clinical features significantly associated with MAKI development: reported urinary abnormalities (OR=23.21, 95%CI=13.75-39.20, P<0.01), male sex (OR=3.92, 95%CI=2.35-6.56, P<0.01), age (OR=1.04, 95%CI=1.01-1.07, P<0.01), hemoglobin level (OR=0.93, 95%CI=0.91-0.96, P<0.01), and BMI (OR=0.94, 95%CI=0.90-0.99, P<0.05). Conclusion The incidence of adult MAKI exhibits seasonal variation closely aligned with P. falciparum infection patterns. MAKI is significantly associated with male sex, advanced age, reported urinary abnormalities, anemia (low hemoglobin), and lower BMI. We recommend incorporating urinary symptom monitoring into the health management of Chinese overseas workers. Enhanced education targeting males, older individuals, and those with lower BMI is crucial. Renal function assessment should be prioritized following malaria diagnosis to reduce MAKI incidence.

Key words: malaria, acute kidney injury, Chinese overseas workers, risk factors, public health