New biomarkers in scorpion stings

Abstract

Scorpion stings have a fatality rate of 0.16%, with the majority of deaths occurring in children. The resources currently available for diagnosing cardiac dysfunction caused by scorpion stings, the most common cause of death, are echocardiograms and laboratory tests, such as troponin, creatine phosphokinase-MB (CKMB), and Brain natriuretic peptide (BNP). The present study aims to evaluate the accuracy of the biomarkers soluble Supression tumorigenicity 2 (sST2) and Heart-type fatty-acid-binding protein (FABP3) in detecting cardiac dysfunction in patients stung by scorpions. This work is a prospective cross-sectional study, carried out between December 2020 and May 2022, with patients, aged 0-19 years, stung by a scorpion. Serum or plasma samples from all patients with signs of severity upon hospital admission were collected and tested with standardized cardiac damage biomarker kits. The results were compared with cardiac dysfunction detected by cardiac ultrasound. This study included 49 patients, the majority female (51%), with a median age of 3.6 years. Left ventricular dysfunction was identified in 13 patients (26.5%), with 7 cases classified as severe. The biomarkers of sST2 and FABP-3 showed an association with left ventricular dysfunction, presenting AUCs of 0.77 and 0.81, respectively. The cut-off values determined for both biomarkers showed a sensitivity of 92.3%. Ultrasensitive troponin presented an AUC of 0.89, with a sensitivity of 84.6%. The study showed an association between sST2 and FABP-3, as well as the presence of acute cardiac dysfunction, identified by cardiac ultrasound. Both biomarkers demonstrated sensitivity in identifying patients with signs of cardiac damage, similar to troponin. The results related to cardiac dysfunction may be linked to the early detection of cardiac lesions and subclinical dysfunctions, enabling faster and more effective interventions. Limitations of this study include the small sample size, data collection in a single center, and the lack of serial measurements of biomarkers.

Keywords: Biomarkers; Fatty acid binding protein 3; Interleukins; Myocarditis; ST2; Scorpion sting.