- Title
- Snakebite-associated thrombotic microangiopathy: an Australian prospective cohort study [ASP30]
- Creator
- Noutsos, Tina; Currie, Bart J.; Isoardi, Katherine Z.; Brown, Simon G. A.; Isbister, Geoffrey K.
- Relation
- NHMRC.1110343 http://purl.org/au-research/grants/nhmrc/1110343
- Relation
- Clinical Toxicology Vol. 60, Issue 2, p. 205-213
- Publisher Link
- http://dx.doi.org/10.1080/15563650.2021.1948559
- Publisher
- Taylor & Francis
- Resource Type
- journal article
- Date
- 2022
- Description
- Background: Snakebite-associated thrombotic microangiopathy (TMA) occurs in a subset of patients with venom-induced consumption coagulopathy (VICC) following snakebite. Acute kidney injury (AKI) is the commonest end-organ manifestation of TMA. The epidemiology, diagnostic features, outcomes, and effectiveness of interventions including therapeutic plasma-exchange (TPE), in snakebite-associated TMA are poorly understood. Methods: We reviewed all patients with suspected or confirmed snakebite recruited to the Australian Snakebite Project (2004-2018 inclusive), a prospective cohort study, from 202 participating Australian hospitals across the country. TMA was defined as anemia with schistocytosis. Results: 2069 patients with suspected snakebite were enrolled, with 1158 (56.0%) systemically envenomed, of which 842 (72.7%) developed VICC, from which 104 (12.4%) developed TMA. Of those systemically envenomed, TMA occurred in 26% (13/50) taipan, 17% (60/351) brown, and 8% (16/197) tiger snakebites. Thrombocytopenia was present in 90% (94/104) of TMA cases, and a further eight (8%) had a > 25% decrease in platelets from the presentation. Patients with TMA were significantly older than non-TMA patients with VICC (53 [35–61] versus 41 [24–55] years, median [IQR], p < 0.0001). AKI developed in 94% (98/104) of TMA patients, with 34% (33/98) requiring dialysis (D-AKI). There were four deaths. In D-AKI TMA cases, eventual dialysis-free survival (DFS) was 97% (32/33). TPE was used in five D-AKI cases, with no significant difference in DFS or time to independence from dialysis. >90-day follow-up for 25 D-AKI cases (130 person-years) showed no end-stage kidney disease but 52% (13/25) had ≥ stage 3 chronic kidney disease (CKD). Conclusion: Our findings support a definition of snakebite-associated TMA as anemia with schistocytosis and either thrombocytopenia or >25% drop in platelet count. AKI occurring with snakebite-associated TMA varied in severity, with most achieving DFS, but with a risk of long-term CKD in half. We found no evidence of benefit for TPE in D-AKI.
- Subject
- snakes; thrombotic microangiopathies; acute kidney injury; hemolysis; schistocytes; SDG 3; Sustainable Development Goals
- Identifier
- http://hdl.handle.net/1959.13/1453951
- Identifier
- uon:44777
- Identifier
- ISSN:1556-3650
- Language
- eng
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