Advancing Snakebite Diagnosis Through Biomarker Analysis: An Insight from a Case-control Study using ELISA
DOI:
https://doi.org/10.48165/jfmt.2026.43.03.10Keywords:
Snakebite Envenomation, Serum Biomarkers, PLA2; HyaluronidaseAbstract
Snakebite envenomation remains a serious and often under-recognized health problem in tropical regions, where rapid and accurate diagnosis can make a major difference to treatment. This study examined serum phospholipase A₂ (PLA₂) and hyaluronidase concentrations measured using human-target ELISA in living snakebite cases and healthy controls. A separate exploratory analysis was also carried out in deceased subjects. The study included 200 living snakebite cases, 122 deceased snakebite cases and 50 controls each. The main diagnostic analysis focused on the 250 living subjects. Serum PLA₂ and hyaluronidase were measured in all subjects using ELISA. Among living participants, both biomarkers were significantly higher in cases than in controls. PLA₂ showed a very large effect (Mann–Whitney U = 9856, p < 0.001; 95% CI 24.14–31.28), whereas hyaluronidase showed a moderate effect (U = 7354, p < 0.001; r = 0.471; median difference 8.06 ng/mL, 95% CI 5.11–11.57). ROC analysis showed an AUC of 0.986 (95% CI 0.971–1.000) for PLA₂ and 0.735 (95% CI 0.653–0.818) for hyaluronidase and the difference between the AUCs was significant (DeLong z = 5.82, p < 0.001). Hyaluronidase was better at distinguishing clinically classified vasculotoxic from neurotoxic cases with an AUC of 0.965, compared with 0.776 for PLA₂. Comparing with living cases, deceased cases had significant results i.e. approximately 84% lower median PLA₂ and 95% lower median hyaluronidase concentrations (p < 0.001). The findings support further evaluation of measured PLA₂ as a marker and hyaluronidase as a complementary marker in living patients for clinical syndrome differentiation.
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