CD163 is marker of activated monocytes/macrophages which is cleaved from cell surface after activation and leading to inflammation.

Monocytes play pivotal role in controlling parasitic (malaria) infection. After the parasite (sporozoites) leave the skin and enter the blood stream, monocytes play their role in cntrolling the burden and contribute to host protection through phagocytosis, cytokine production and antigen presentation, but they also drive inflammation and sequestration of infected RBCs. Severe Malarial Anemia is caused by sequestration of RBCs in the spleen, loss of RBCs and suppression of erythropoiesis and dyserythropoiesis in the bone marrow.

This condition is followed by acute lung failure or ARDS leading to severity.

As the major complication of malaria is loss of RBC leading to respiratory distress and further complications is caused by higher activation of monocytes which is directly correlated by disease severity.

Higher the CD163 in serum is much severity.

This is common phenomenon for much of the parasitic infections, not alone malaria severity.

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Please see the following RG links.

Article Levels of Soluble CD163 and Severity of Malaria in Children in Ghana

Article Association between the Haptoglobin and Heme Oxygenase 1 Gen...

sCD163 level increased in uncomplicated malaria patient because it plays protection role to prevent complication, while other severe complication shows low level of sCD163, thus the effect of inflammation will be persisting.