Abstract
Objective: To assess the accuracy and marginal value of quantitative D-dimer testing for diagnosing venom-induced consumption coagulopathy (VICC) in people bitten by Australian snakes.
Design, setting: Analysis of data for suspected and confirmed cases of snakebite collected prospectively by the Australian Snakebite Project, 2005–2019, from 200 hospitals across Australia.
Participants: 1363 patients for whom D-dimer was quantitatively assessed within 24 hours of suspected or confirmed snakebite.
Main outcome measures: Diagnostic performance of quantitative D-dimer testing for detecting systemic envenoming with VICC (area under the receiver operating characteristic curve, AUC); optimal D-dimer cut-off value (maximum sum of sensitivity and specificity).
Results: D-dimer values exceeded 2.5 mg/L within three hours of the bite for 95% of patients who developed VICC, and were lower than 2.5 mg/L for 95% of non-envenomed patients up to six hours after snakebite. The AUC for diagnosing envenoming with VICC on the basis of quantitative D-dimer testing within six hours of snakebite was 0.97 (95% CI, 0.96–0.98; 944 patients). Diagnostic performance increased during the first three hours after snakebite; for quantitative D-dimer testing at 2–6 hours, the AUC was 0.99 (95% CI, 0.99–1.0); with a cut-off of 2.5 mg/L, sensitivity was 97.1% (95% CI, 95.0–98.3%) and specificity 99.0% (95% CI, 97.6–99.6%) for VICC. For 36 patients with normal international normalised ratio (INR) and activated partial thromboplastin time (aPTT) values 2–6 hours after snakebite, the AUC was 0.97 (95% CI, 0.93–1.0); with a cut-off of 1.4 mg/L, sensitivity was 94% (95% CI, 82–99%) and specificity 96% (95% CI, 94–97%). In all but one of 84 patients who developed VICC-related acute kidney injury, D-dimer values exceeded 4 mg/L within 24 hours of the bite.
Conclusion: D-dimer concentrations assessed 2–6 hours after snakebite, with a cut-off value of 2.5 mg/L, could be useful for diagnosing envenoming with VICC.
| Original language | English |
|---|---|
| Pages (from-to) | 203-207 |
| Number of pages | 5 |
| Journal | Medical Journal of Australia |
| Volume | 217 |
| Issue number | 4 |
| DOIs | |
| Publication status | Published - 15 Aug 2022 |
Bibliographical note
Funding Information:Geoffrey Isbister is supported by a National Health and Medical Research Council (NHMRC) Senior Research Fellowship (1154503). The study was funded by an NHMRC Centre for Research Excellence Grant (1110343). We acknowledge the assistance of the Australian Snakebite Project Research database administrators, including Kylie Tape (University of Newcastle; The Mater Hospital, Newcastle) and the local co‐investigators, and the medical, nursing, and laboratory staff at referring centres around Australia who assisted in patient recruitment and data collation.
Funding Information:
Geoffrey Isbister is supported by a National Health and Medical Research Council (NHMRC) Senior Research Fellowship (1154503). The study was funded by an NHMRC Centre for Research Excellence Grant (1110343). We acknowledge the assistance of the Australian Snakebite Project Research database administrators, including Kylie Tape (University of Newcastle; The Mater Hospital, Newcastle) and the local co-investigators, and the medical, nursing, and laboratory staff at referring centres around Australia who assisted in patient recruitment and data collation.
Publisher Copyright:
© 2022 The Authors. Medical Journal of Australia published by John Wiley & Sons Australia, Ltd on behalf of AMPCo Pty Ltd.