LAUSR

Acute kidney injury (AKI) is a frequent and potentially fatal complications of snakebites. Coagulation disturbances are observed and have a high probability to be involved in AKI pathogenesis. Novel endothelial inflammation biomarkers are capable of predicting disease severity and could be used in the setting of snakebites. This is a prospective study conducted at the Instituto Dr. José Frota, a reference hospital for toxicological assistance in Fortaleza, Northeast Brazil. Blood and urine samples were collected from patients admitted after snakebite accident, without comorbidities, in 3 different time-points post-bite: on admission (until 8h post-bite), 12 to 16h, and 24-48h. The samples were stored in microtubes, frozen in a freezer (-80ºC) until performance of the laboratory tests. To measure the novel biomarkers the following ELISA kits were used: Angiopoietin-1 (R&D Systems–Duoset DY623), Angiopoietin-2 (R&D Systems–Duoset DY623) and Vascular cell adhesion protein 1  (VCAM-1) (Abcam–ab47355). All procedures were conducted according to the manufacturer’s guidelines. AKI was defined according to Kidney Disease Improving Global Outcomes (KDIGO) criteria. Patients were divided in 2 groups: with and without AKI. A total of 26 patients were included in the study:23 (88.5%) victims of Bothrops accident and 3 (11.5%) Crotalus accidents. AKI was observed in 11 cases. The 2 groups did not differ in age, gender, electrolytes levels, creatine kinase (CK), hemoglobin and hematocrit levels. There were significant differences regarding the levels of angiopoietin 1 (16.39±8.1 vs 4.35±7.36; p=0.0054) and VCAM-1 (1293±528 vs 811.3±234; p=0.0175), both in the second sample (12-16h after bite). The analysis of ROC curve revealed that angiopoietin 1 (AUC: 0.8182, 95% CI0.63–0.99, p=0.0064) and VCAM-1 (AUC: 0.77, 95% CI0.57–0.97, p=0.0182) presented good accuracy for AKI prediction in the studied population. Endothelial inflammation biomarkers (VCAM-1 and angiopoietin 1) have good accuracy for snakebites-associated AKI diagnosis. The time 12-16h after the bite had the best result in predicting AKI in this setting.