Universidade de Brasília, Núcleo de Medicina Tropical, Brasília, DF, Brasil.
Conselho Nacional de Desenvolvimento Científico e Tecnológico, Instituto de Avaliação de Tecnologias em Saúde, Porto Alegre, RS. Brasil.
Rev Soc Bras Med Trop. 2022 Jul 25;55:e05582021. doi: 10.1590/0037-8682-0558-2021. eCollection 2022.
Snakebites are a major problem in developing countries owing to their high morbidity rates, severity, and sequelae. In Brazil, most cases of envenomation are caused by Bothrops and Lachesis snakes. The present study aimed to evaluate variables associated with death, systemic complications, and amputations in victims of envenomation due to Bothrops or Lachesis snake.
An analytical epidemiological study was performed with data from the Notifiable Diseases Information System (Sistema de Informação de Agravos de Notificação [SINAN]) relating to the Brazilian Amazon for the period 2010-2015. A hierarchical Poisson regression analysis was performed with three aspects, namely, individual characteristics, sociodemographic characteristics, and clinical conditions.
The following associations were observed: i) advanced age (>65 years), sepsis, renal failure, and hemorrhagic manifestations were related to two outcomes - death due to snakebite and death from all causes; ii) more advanced age (≥46 years), time to health care longer than 6 hours, renal and hemorrhagic manifestations, and region of occurrence being rural areas were associated with systemic complications; and iii) children (up to 12 years old) were associated with amputations.
Knowledge of the characteristics associated with severe outcomes in snakebites may help identify patients who will require more intensive care or longer follow-up and may provide the physician with counseling rationale for their possible prognosis.
由于发病率高、病情严重且会遗留后遗症，蛇咬伤是发展中国家的一个重大问题。在巴西，大多数蛇伤是由矛头蝮属和矛头蝮属蛇引起的。本研究旨在评估与因矛头蝮属或矛头蝮属蛇咬伤而导致死亡、全身并发症和截肢相关的变量。
采用分析性流行病学研究方法，对 2010 年至 2015 年期间巴西亚马逊地区的法定传染病报告信息系统（Sistema de Informação de Agravos de Notificação [SINAN]）中的数据进行了分析。采用分层泊松回归分析方法，从个体特征、社会人口学特征和临床状况三个方面进行分析。
观察到以下关联：i）年龄较大（>65 岁）、败血症、肾衰竭和出血表现与两种结局有关——蛇伤导致的死亡和所有原因导致的死亡；ii）年龄较大（≥46 岁）、就医时间超过 6 小时、肾脏和出血表现以及发生在农村地区与全身并发症相关；iii）儿童（12 岁以下）与截肢有关。
了解与蛇咬伤严重后果相关的特征，可能有助于识别需要更强化治疗或更长时间随访的患者，并为医生提供可能预后的咨询依据。
