221 - Association of a Cytokine Response Network With Functional Recovery From Snake Envenomation
Thursday, May 14, 2020
8:00 AM – 8:08 AM
Location: Beverly: Terrace Level
Participants should be aware of the following financial/non-financial relationships:
Charles Gerardo: BTG International Inc (Products/Services: antivenom) (Clinical Condition: snakebite) (Grants/Research Support Recipient)
Elizabeth Silvius: No disclosure data submitted.
Seth Schobel: No disclosure data submitted.
John Eppensteiner: No disclosure data submitted.
Lauren McGowan: No disclosure data submitted.
Alexander Limkakeng, MD, MHS: No disclosure data submitted.
Allan D. Kirk: No disclosure data submitted.
Eric A. Elster: No disclosure data submitted.
Joao Ricardo Nickenig Vissoci, PhD: No disclosure data submitted.
Background and Objectives: Snake envenomation activated inflammatory pathways’ association with recovery is unclear. An improved understanding of this relationship will provide diagnostic and prognostic targets. The purpose of this study was to identify patterns of pre- and post-envenomation cytokines that are associated with recovery from snake envenoming.
Methods: We performed a prospective cohort study at an academic medical center emergency department. We enrolled consecutive patients with snake envenomation and obtained serum samples based on criteria for the Surgical Critical Care Initiative (ClinicalTrials.gov Identifier: NCT02182180). We measured levels of 35 cytokines using Luminex Cytokine 35-Plex Human Panel (Thermo Fisher Scientific, Waltham, MA) pre- and post-antivenom administration. We assessed a well-validated patient-reported outcome of functional recovery, Patient-Specific Functional Scale, at 0, 7, 14, 21 and 28 days. We performed Bayesian Belief Network modelling, a machine learning technique, to represent relationships. We report associations of this cytokine model with the patient’s recovery curve.
Results: Twenty-eight snake envenoming patients were enrolled. Preliminary results from 9 patients with pre-antivenom and 11 patients with post-antivenom cytokine data are presented. The group was mostly female (81.8%) with a mean age of 35 (SD ± 9.8) years. Monocyte chemoattractant protein 1 and interleukin 1a are most closely related with recovery in the pre-antivenom network, while the most influential cytokines were interleukin 13, interleukin 1ra, endothelial growth factor, and vascular endothelial growth factor and Regulated On Activation Normal T Cell Expressed And Secreted cytokine, interleukin 1 and interferon gamma were most closely related with recovery in the post-antivenom network. Macrophage inflammatory protein 1b, hepatocyte growth factor, and eosinophil chemoattractant cytokine were most influential.
Conclusion: Pre- and post-envenomation cytokine networks were associated with functional recovery over time. These networks included both innate and adaptive immune system responses. With additional patient data, we can identify cytokine-based predictive models of recovery from snake envenoming.