Association of Advanced Age with Liver Function and Inflammatory Response in Patients with Malaria in Luanda, Angola

Background: Malaria remains a leading cause of mortality in sub-Saharan Africa, however, the clinical profile of older adults with malaria remains poorly characterized. Herein, we investigated age-related differences in liver function and inflammatory response among hospitalized patients with malaria in Luanda, Angola. Methods: We conducted a cross-sectional study of 518 patients with malaria admitted in tertiaries hospitals in Luanda, Angola, between January 2023 and December 2024. Hepatic biomarkers, inflammatory markers, and leukocyte parameters were compared between patients aged ≤50 and >50 years. Logistic regression identified factors associated with advanced age. Results: Older adults (>50 years) represented 9.8% of patients. Gender, residence, parasitaemia level, and HbS genotype were not associated with age group (p>0.05). Patients with normal ALT (OR: 0.30, p<0.001), elevated ALT (OR: 0.33, p=0.002), normal AST (OR: 0.30, p<0.001) elevated AST (OR: 0.33, p=0.002), normal GGT (OR: 0.30, p<0.001) and elevated GGT (OR: 0.33, p=0.002) had significantly lower odds of belonging to the older age group. Likewise, patients with normal (OR: 0.30, p<0.001) or elevated direct bilirubin (OR: 0.33, p=0.002) had lower odds of advanced age, while abnormal total bilirubin was more frequent among younger adults (p=0.015). Positive C-reactive protein was less frequent in older adults (63.3% vs. 85.2%, p<0.001). Moderate (OR: 0.33, p=0.001) and high inflammatory score (OR: 0.15, p=0.004) were associated with lower odds of advanced age. Lymphocyte count was positively associated with older age (OR: 1.02, p=0.031). Conclusions: Older adults with malaria presented a distinct liver function profile and an attenuated inflammatory response, despite similar parasitaemia, which emphasises the need for age-adapted clinical care and surveillance strategies to improve outcomes in elderly populations living in malaria-endemic areas.