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Snakebites of the genus Bothrops account for 90% of reported cases in Brazil. Acute kidney injury (AKI) is a potentially serious complication, exhibiting mortality rates between 13 to 19%. The primary objective of the current investigation is to elucidate the incidence of AKI in accidents involving Bothrops envenomation, and to analyze its correlation with pertinent clinical and laboratory manifestations.
This is a retrospective and descriptive study that reviewed data from Toxicology Information and Assistance Center (ToxIAC). The study comprises patients with botropic accidents treated at the Hospital de Base in Sao Jose do Rio Preto from January 1, 2012, to December 31, 2021. Inclusion criteria comprised patients with confirmed botropic accidents who underwent at least two creatinine level assessments. Exclusion criteria encompassed individuals lacking clinical or laboratory symptoms and those who received anti-botropic serum (SAB) treatment in a different medical facility. AKI was diagnosed utilizing the KDIGO criteria. Subsequently, patients were categorically divided into two groups: those who developed AKI (AKI group) and those who did not (NON-AKI group).
Among the 416 patients analyzed, 257 were included in the study. Of these, 76 presented Acute Kidney Injury (AKI) (29.5%), and 2 required renal replacement therapy. The AKI group had a higher mean age (AKI: 50.2 ± 16.2 vs. Non-AKI: 43.8 ± 18.9; p < 0.01), although the rate of male patients was similar. Both groups exhibited similar rates of patients with diabetes and hypertension. The AKI group had a higher proportion of accidents classified as severe (AKI: 17.1% vs. Non-AKI: 6.6%, p = 0.01). Regarding the location of the snakebite, there was no difference between the two groups. When evaluating serum therapy, the AKI group received a higher number of doses (AKI: 6 [4.25-8] vs. Non-AKI: 5 [3-6], p = 0.01). However, the time between the snakebite and the administration of serum in minutes was similar in both groups (AKI: 225 [160-295] vs. Non-AKI: 220 [164-320], p = NS). There was no difference in the rate of corticosteroid or non-steroidal anti-inflammatory drug used between the two groups. The AKI group had a higher infection rate (AKI: 38.1% vs. Non-AKI: 24.8%; p = 0.03). When assessing laboratory exams, the AKI group presented higher admission, peak, and discharge creatinine levels compared to the Non-AKI group (AKI: 1.2 [0.9-1.47], 1.5 [1.22-2.37], 1.15 [0.9-1.5] vs. Non-AKI: 1 [0.9-1.2], 1 [0.9-1.2], 0.9 [0.8-1.1]; p < 0.0001) respectively. In addition, there was a higher incidence of thrombocytopenia (AKI: 28.95% vs. Non-AKI: 14.36%; p = 0.0084), incoagulable INR (AKI: 57.89% vs. Non-AKI: 34.25%; p = 0.0005), hematuria (AKI: 49.37% vs. Non-AKI: 23.20%; p < 0.0001), and proteinuria (AKI: 84.21% vs. Non-AKI: 59.12%; p < 0.0001) in the AKI group. The length of hospital stay was longer in the AKI group (AKI: 3 [2-5] vs. Non-AKI: 2 [1-3]; p < 0.01), as was its mortality rate (AKI: 5.2% vs. Non-AKI: 0%; p < 0.001).
The incidence of AKI in botropic accidents, as revealed by the study, was 29.5%. The AKI group exhibited a higher rate of cases classified as severe, along with an extended duration of hospitalization and a higher mortality rate.