Phospholipase A2 (PLA<sub>2</sub>) as an Early Indicator of Envenomation in Australian Elapid Snakebites (ASP-27)
Early diagnosis of snake envenomation is essential, especially neurotoxicity and myotoxicity. We investigated the diagnostic value of serum phospholipase (PLA<sub>2</sub>) in Australian snakebites. In total, 115 envenomated and 80 non-envenomated patients were recruited over 2 years, in...
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doaj-03e8da31074e4b02b75076a69fca47922020-11-25T02:42:08ZengMDPI AGBiomedicines2227-90592020-10-01845945910.3390/biomedicines8110459Phospholipase A2 (PLA<sub>2</sub>) as an Early Indicator of Envenomation in Australian Elapid Snakebites (ASP-27)Geoffrey K. Isbister0Nandita Mirajkar1Kellie Fakes2Simon G. A. Brown3Punnam Chander Veerati4Clinical Toxicology Research Group, University of Newcastle, Newcastle, NSW 2298, AustraliaClinical Toxicology Research Group, University of Newcastle, Newcastle, NSW 2298, AustraliaClinical Toxicology Research Group, University of Newcastle, Newcastle, NSW 2298, AustraliaAeromedical and Retrieval Medicine, Ambulance Tasmania, Hobart, TAS 7001, AustraliaClinical Toxicology Research Group, University of Newcastle, Newcastle, NSW 2298, AustraliaEarly diagnosis of snake envenomation is essential, especially neurotoxicity and myotoxicity. We investigated the diagnostic value of serum phospholipase (PLA<sub>2</sub>) in Australian snakebites. In total, 115 envenomated and 80 non-envenomated patients were recruited over 2 years, in which an early blood sample was available pre-antivenom. Serum samples were analyzed for secretory PLA<sub>2</sub> activity using a Cayman sPLA<sub>2</sub> assay kit (#765001 Cayman Chemical Company, Ann Arbor MI, USA). Venom concentrations were measured for snake identification using venom-specific enzyme immunoassay. The most common snakes were <i>Pseudonaja</i> spp. (33), <i>Notechis scutatus</i> (24), <i>Pseudechis porphyriacus</i> (19) and <i>Tropidechis carinatus</i> (17). There was a significant difference in median PLA<sub>2</sub> activity between non-envenomated (9 nmol/min/mL; IQR: 7–11) and envenomated patients (19 nmol/min/mL; IQR: 10–66, <i>p</i> < 0.0001) but <i>Pseudonaja</i> spp. were not different to non-envenomated. There was a significant correlation between venom concentrations and PLA<sub>2</sub> activity (r = 0.71; <i>p</i> < 0.0001). PLA<sub>2</sub> activity was predictive for envenomation; area under the receiver-operating-characteristic curve (AUC-ROC), 0.79 (95% confidence intervals [95%CI]: 0.72–0.85), which improved with brown snakes excluded, AUC-ROC, 0.88 (95%CI: 0.82–0.94). A cut-point of 16 nmol/min/mL gives a sensitivity of 72% and specificity of 100% for Australian snakes, excluding <i>Pseudonaja</i>. PLA<sub>2</sub> activity was a good early predictor of envenomation in most Australian elapid bites. A bedside PLA<sub>2</sub> activity test has potential utility for early case identification but may not be useful for excluding envenomation.https://www.mdpi.com/2227-9059/8/11/459snakebiteenvenomationphospholipasediagnosisantivenomvenom |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Geoffrey K. Isbister Nandita Mirajkar Kellie Fakes Simon G. A. Brown Punnam Chander Veerati |
spellingShingle |
Geoffrey K. Isbister Nandita Mirajkar Kellie Fakes Simon G. A. Brown Punnam Chander Veerati Phospholipase A2 (PLA<sub>2</sub>) as an Early Indicator of Envenomation in Australian Elapid Snakebites (ASP-27) Biomedicines snakebite envenomation phospholipase diagnosis antivenom venom |
author_facet |
Geoffrey K. Isbister Nandita Mirajkar Kellie Fakes Simon G. A. Brown Punnam Chander Veerati |
author_sort |
Geoffrey K. Isbister |
title |
Phospholipase A2 (PLA<sub>2</sub>) as an Early Indicator of Envenomation in Australian Elapid Snakebites (ASP-27) |
title_short |
Phospholipase A2 (PLA<sub>2</sub>) as an Early Indicator of Envenomation in Australian Elapid Snakebites (ASP-27) |
title_full |
Phospholipase A2 (PLA<sub>2</sub>) as an Early Indicator of Envenomation in Australian Elapid Snakebites (ASP-27) |
title_fullStr |
Phospholipase A2 (PLA<sub>2</sub>) as an Early Indicator of Envenomation in Australian Elapid Snakebites (ASP-27) |
title_full_unstemmed |
Phospholipase A2 (PLA<sub>2</sub>) as an Early Indicator of Envenomation in Australian Elapid Snakebites (ASP-27) |
title_sort |
phospholipase a2 (pla<sub>2</sub>) as an early indicator of envenomation in australian elapid snakebites (asp-27) |
publisher |
MDPI AG |
series |
Biomedicines |
issn |
2227-9059 |
publishDate |
2020-10-01 |
description |
Early diagnosis of snake envenomation is essential, especially neurotoxicity and myotoxicity. We investigated the diagnostic value of serum phospholipase (PLA<sub>2</sub>) in Australian snakebites. In total, 115 envenomated and 80 non-envenomated patients were recruited over 2 years, in which an early blood sample was available pre-antivenom. Serum samples were analyzed for secretory PLA<sub>2</sub> activity using a Cayman sPLA<sub>2</sub> assay kit (#765001 Cayman Chemical Company, Ann Arbor MI, USA). Venom concentrations were measured for snake identification using venom-specific enzyme immunoassay. The most common snakes were <i>Pseudonaja</i> spp. (33), <i>Notechis scutatus</i> (24), <i>Pseudechis porphyriacus</i> (19) and <i>Tropidechis carinatus</i> (17). There was a significant difference in median PLA<sub>2</sub> activity between non-envenomated (9 nmol/min/mL; IQR: 7–11) and envenomated patients (19 nmol/min/mL; IQR: 10–66, <i>p</i> < 0.0001) but <i>Pseudonaja</i> spp. were not different to non-envenomated. There was a significant correlation between venom concentrations and PLA<sub>2</sub> activity (r = 0.71; <i>p</i> < 0.0001). PLA<sub>2</sub> activity was predictive for envenomation; area under the receiver-operating-characteristic curve (AUC-ROC), 0.79 (95% confidence intervals [95%CI]: 0.72–0.85), which improved with brown snakes excluded, AUC-ROC, 0.88 (95%CI: 0.82–0.94). A cut-point of 16 nmol/min/mL gives a sensitivity of 72% and specificity of 100% for Australian snakes, excluding <i>Pseudonaja</i>. PLA<sub>2</sub> activity was a good early predictor of envenomation in most Australian elapid bites. A bedside PLA<sub>2</sub> activity test has potential utility for early case identification but may not be useful for excluding envenomation. |
topic |
snakebite envenomation phospholipase diagnosis antivenom venom |
url |
https://www.mdpi.com/2227-9059/8/11/459 |
work_keys_str_mv |
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