Schistocyte quantitation, thrombotic microangiopathy and acute kidney injury in Australian snakebite coagulopathy [ASP28].
Schistocyte quantitation, thrombotic microangiopathy and acute kidney injury in Australian snakebite coagulopathy [ASP28].
复制标题
DOI：
10.1111/ijlh.13497
复制
发表时间：
2021-10
影响因子：
3
通讯作者：
Isbister GK
中科院分区：
文献类型：
--
作者：
Noutsos T;Currie BJ;Brown SG;Isbister GK
人蛇咬伤蛇毒血液毒性的主要全身性表现是毒液诱导的消耗性凝血障碍(VICC)。部分VICC患者发展为血栓性微血管病变(TMA)，发生急性肾损伤(AKI)。我们的目的是调查与非蛇毒伤患者相比，蛇咬伤患者中VICC和AKI患者的血吸虫病之间的关系。对从一组预期的蛇咬伤患者(澳大利亚蛇咬伤项目)收集的连续血片进行了检查。根据已定义的临床和实验室标准，先验病例分为无毒蛇咬伤(正常对照)、无VICC毒蛇咬伤、部分VICC无AKI、完全性VICC无AKI和VICC合并AKI。用Kendall‘s tau b检验比较各组间的裂殖细胞百分率。对2 34例蛇咬伤患者的780份血片进行了分析。无毒蛇咬伤、部分毒蛇咬伤、部分毒蛇咬伤、完全毒蛇咬伤、完全性毒蛇咬伤和有AKI毒蛇咬伤组之间的血吸虫病有显著的统计学意义(τ=0.69，SE.03，P<；9.001)。合并急性心肌梗死患者的血小板最低值为42×10~9/L(四分位数范围为25~130×10~9/L)，血红蛋白最低值为107~122g/L(四分位数区间为66~122g/L)，最大乳酸脱氢酶中位数为1128U/L(四分位数范围为474~3255U/L)。以1.0%的血吸虫病阈值预测VICC患者AKI的敏感性为90%(95%CI：67%-98%)，特异性为71%(95%CI：62%-79%)。血细胞定量对蛇咬伤合并VICC有较好的诊断价值。将蛇咬伤TMA定义为有≥1.0%的血细胞和血小板减少的MAHA似乎是合适的。
The major systemic manifestation of hemotoxicity in human snakebite envenoming is venom‐induced consumption coagulopathy (VICC). A subset of patients with VICC develop thrombotic microangiopathy (TMA), in which acute kidney injury (AKI) occurs. We aimed to investigate the association between schistocytosis in snakebite patients with VICC and AKI, compared to non‐envenomed patients. Serial blood films collected from a prospective cohort of snakebite patients (Australian Snakebite Project) were examined. Cases were classified a priori as non‐envenomed snakebites (normal controls), envenomed without VICC, partial VICC without AKI, complete VICC without AKI, and VICC with AKI based on defined clinical and laboratory criteria. The percentage of schistocytes between groups was compared and correlated by Kendall's tau b test. Seven hundred and eighty blood films from 234 snakebite cases were analyzed. There was a statistically significant correlation (τ = .69, SE .03, P < .001) for schistocytosis between the ordered groups of non‐envenomed snakebites, envenomed without VICC, partial VICC without AKI, complete VICC without AKI, and VICC with AKI groups. Patients with VICC and AKI had a platelet nadir median of 42 × 109/L (interquartile range [IQR] :25‐130 × 109/L), hemoglobin nadir of median 107 g/L (IQR 66‐122 g/L), and maximum LDH median of 1128 U/L (IQR 474‐3255 U/L). A 1.0% threshold for schistocytosis yielded 90% sensitivity (95% CI: 67%‐98%) and 71% specificity (95% CI: 62%‐79%) for predicting AKI in patients with VICC. Schistocyte quantitation has good diagnostic utility in snakebite patients with VICC. A definition of snakebite TMA as MAHA with ≥1.0% schistocytes and thrombocytopenia, would appear to be appropriate.
登录
查看更多内容
影响因子：
3.8
作者：
Maduwage K;Isbister GK
通讯作者：
Isbister GK
影响因子：
3
作者：
Levi, M.
通讯作者：
Levi, M.
影响因子：
13.2
作者：
CHUGH, KS;PAL, Y;SOMMERS, SC
通讯作者：
SOMMERS, SC
影响因子：
11.4
作者：
Johnston, Christopher I.;Ryan, Nicole M.;Isbister, Geoffrey K.
通讯作者：
Isbister, Geoffrey K.
影响因子：
3.5
作者：
Lesesve, JF;Salignac, S;Lecompte, T
通讯作者：
Lecompte, T