Jose Diego de Brito Sousa1,2, Sâmella Silva de Oliveira1,2, Jacqueline Sachett1,2,3, Hui Wen Fan4, Wuelton Marcelo Monteiro1,2. 1. a Instituto de Pesquisa Clínica Carlos Borborema, Fundacão de Medicina Tropical Dr. Heitor Vieira Dourado , Manaus , Brazil. 2. b Universidade do Estado do Amazonas , Manaus , Brazil. 3. c Fundação Alfredo da Matta , Manaus , Brazil. 4. d Instituto Butantan, Divisão de Desenvolvimento Tecnológico e Produção , São Paulo , Brazil.
Abstract
Introduction: The common lancehead snakes (Bothrops atrox) are responsible for up to 90% of snakebites in the Amazon, especially in remote areas. The prevalence of microhematuria is similar to that of coagulopathy in B. atrox envenomation in the Amazon. Thus, this study aimed to assess the reliability of microhematuria as an inexpensive and simple alternative to detect snake-induced consumption coagulopathy. Methods: We analyzed samples from patients with confirmed B. atrox envenomation in terms of plasma fibrinogen and microhematuria (>3 red blood cells per high power field) in order to access the reliability of microhematuria to detect snakebite-induced coagulopathy, within 12 hours from admission. Results: A total of 186 patients were recruited. From the total, 85.5% of patients had hypofibrinogenemia and only about 50% (n = 94) had a microscopic examination of urine within 12 hours where microhematuria was present in 39 (41.5%). Diagnostic performance showed 38.6% sensitivity and 36.4% specificity (cutpoint 200 mg/dL). No clear association was seen between microhematuria and hypofibrinogenemia (r: -0.10; p: .34). Conclusion: In this study, microhematuria presented poor diagnostic performance to detect coagulopathy. Further studies are necessary to screen inexpensive and simple alternative diagnostic tools.
Introduction: The common lancehead snakes (Bothrops atrox) are responsible for up to 90% of snakebites in the Amazon, especially in remote areas. The prevalence of microhematuria is similar to that of coagulopathy in B. atrox envenomation in the Amazon. Thus, this study aimed to assess the reliability of microhematuria as an inexpensive and simple alternative to detect snake-induced consumption coagulopathy. Methods: We analyzed samples from patients with confirmed B. atrox envenomation in terms of plasma fibrinogen and microhematuria (>3 red blood cells per high power field) in order to access the reliability of microhematuria to detect snakebite-induced coagulopathy, within 12 hours from admission. Results: A total of 186 patients were recruited. From the total, 85.5% of patients had hypofibrinogenemia and only about 50% (n = 94) had a microscopic examination of urine within 12 hours where microhematuria was present in 39 (41.5%). Diagnostic performance showed 38.6% sensitivity and 36.4% specificity (cutpoint 200 mg/dL). No clear association was seen between microhematuria and hypofibrinogenemia (r: -0.10; p: .34). Conclusion: In this study, microhematuria presented poor diagnostic performance to detect coagulopathy. Further studies are necessary to screen inexpensive and simple alternative diagnostic tools.
Authors: Wuelton Marcelo Monteiro; Jorge Carlos Contreras-Bernal; Pedro Ferreira Bisneto; Jacqueline Sachett; Iran Mendonça da Silva; Marcus Lacerda; Allyson Guimarães da Costa; Fernando Val; Lisele Brasileiro; Marco Aurélio Sartim; Sâmella Silva-de-Oliveira; Paulo Sérgio Bernarde; Igor L Kaefer; Felipe Gobbi Grazziotin; Fan Hui Wen; Ana Maria Moura-da-Silva Journal: Toxicon X Date: 2020-04-23
Authors: Isadora S Oliveira; Carla B Ananias; Jilvando M Medeiros; Michelle V S Franco; Isabela G Ferreira; Felipe A Cerni; Eliseu A Sandri; Wuelton M Monteiro; Manuela B Pucca Journal: Toxins (Basel) Date: 2022-07-16 Impact factor: 5.075