- Title
- Phospholipase A2 (PLA(2)) as an Early Indicator of Envenomation in Australian Elapid Snakebites (ASP-27)
- Creator
- Isbister, Geoffrey K.; Mirajkar, Nandita; Fakes, Kellie; Brown, Simon G. A.; Veerati, Punnam Chander
- Relation
- NHMRC.1110343 http://purl.org/au-research/grants/nhmrc/1110343 & 1154503
- Relation
- Biomedicines Vol. 8, Issue 11, no. 459
- Publisher Link
- http://dx.doi.org/10.3390/biomedicines8110459
- Publisher
- MDPI AG
- Resource Type
- journal article
- Date
- 2020
- Description
- Early diagnosis of snake envenomation is essential, especially neurotoxicity and myotoxicity. We investigated the diagnostic value of serum phospholipase (PLA2) 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 PLA2 activity using a Cayman sPLA2 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 Pseudonaja spp. (33), Notechis scutatus (24), Pseudechis porphyriacus (19) and Tropidechis carinatus (17). There was a significant difference in median PLA2 activity between non-envenomated (9 nmol/min/mL; IQR: 7–11) and envenomated patients (19 nmol/min/mL; IQR: 10–66, p < 0.0001) but Pseudonaja spp. were not different to non-envenomated. There was a significant correlation between venom concentrations and PLA2 activity (r = 0.71; p < 0.0001). PLA2 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 Pseudonaja. PLA2 activity was a good early predictor of envenomation in most Australian elapid bites. A bedside PLA2 activity test has potential utility for early case identification but may not be useful for excluding envenomation.
- Subject
- snakebite; envenomation; phospholipase; diagnosis; antivenom; venom
- Identifier
- http://hdl.handle.net/1959.13/1443408
- Identifier
- uon:41985
- Identifier
- ISSN:2227-9059
- Language
- eng
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