Kumar Manoj, Arcot Thanjan Maasila, Gopalakrishnan Natarajan, Jeyachandran Dhanapriya, Thanigachalam Dineshkumar, Ramanathan Sakthirajan
Institute of Nephrology, Madras Medical College, Chennai, Tamil Nadu, India
Nephrology, Government Vellore Medical College and Hospital, Vellore, Tamil Nadu, India.
Postgrad Med J. 2022 Apr;98(1158):264-268. doi: 10.1136/postgradmedj-2020-139021. Epub 2021 Mar 10.
Snake bite continues to be a significant cause of acute kidney injury (AKI) in India. There is paucity of data regarding long-term outcomes of such patients. In this study, we aim to assess the prognosis and long-term renal outcomes of such patients.
We analysed the hospital records of snake envenomation-induced AKI from January 2015 to December 2018. Predictors of in-hospital mortality were assessed. Survivors were advised to visit follow-up clinic to assess their kidney function.
There were 769 patients with evidence of envenomation and of them, 159 (20.7%) had AKI. There were 112 (70.4%) males. Mortality occurred in 9.4% of patients. Logistic regression analysis identified shock (OR 51.949, 95% CI 4.297 to 628.072) and thrombocytopenia (OR 27.248, 95% CI 3.276 to 226.609) as predictors of mortality. Forty-three patients attended the follow-up. The mean follow-up duration was 30.4±15.23 months. Adverse renal outcomes (eGFR <60 mL/min/1.73 m or new-onset hypertension (HTN) or pre-HTN or urine protein creatinine ratio >0.3) occurred in 48.8% of patients. Older age (mean age (years) 53.3 vs 42.8, p=0.004) and longer duration on dialysis (median duration (days) 11.5 vs 5, p=0.024) were significantly associated with adverse renal outcomes.
The incidence of AKI in snake envenomation was 20.7%. The presence of shock and thrombocytopenia were associated with mortality. Adverse renal outcomes occurred in 48.8% of patients in the long term.
在印度，蛇咬伤仍是急性肾损伤（AKI）的一个重要原因。关于这类患者长期预后的数据匮乏。在本研究中，我们旨在评估这类患者的预后及长期肾脏结局。
我们分析了2015年1月至2018年12月期间蛇毒中毒所致AKI的医院记录。评估了院内死亡的预测因素。建议幸存者前往随访门诊评估其肾功能。
有769例有蛇毒中毒证据的患者，其中159例（20.7%）发生了AKI。男性有112例（70.4%）。9.4%的患者死亡。逻辑回归分析确定休克（比值比51.949，95%置信区间4.297至628.072）和血小板减少（比值比27.248，95%置信区间3.276至226.609）为死亡的预测因素。43例患者参加了随访。平均随访时间为30.4±15.23个月。48.8%的患者出现了不良肾脏结局（估算肾小球滤过率<60 mL/min/1.73 m²或新发高血压或高血压前期或尿蛋白肌酐比值>0.3）。年龄较大（平均年龄（岁）53.3对42.8，p = 0.004）和透析时间较长（中位时间（天）11.5对5，p = 0.024）与不良肾脏结局显著相关。
蛇毒中毒中AKI的发生率为20.7%。休克和血小板减少的存在与死亡率相关。长期来看，48.8%的患者出现了不良肾脏结局。
