Clinical Characteristics and Major Complications of <i>Echis carinatus</i> Envenomation: A Retrospective Cohort Study

Abstract

Background: Envenomation by Echis carinatus is associated with significant morbidity, particularly coagulopathy and renal complications. However, data on the clinical characteristics and major complications of Echis envenomation in endemic regions remain limited. Objectives: This retrospective cohort study aimed to describe the clinical and laboratory characteristics of patients with E. carinatus envenomation and to evaluate the associations among major complications, including venom-induced consumption coagulopathy (VICC), acute kidney injury (AKI), and cellulitis. Methods: In this retrospective cohort study, medical records of patients with confirmed or highly suspected E. carinatus envenomation admitted to a tertiary referral center were reviewed. Demographic, clinical, and laboratory data were extracted. Acute kidney injury was defined according to serum creatinine changes during hospitalization. Venom-induced consumption coagulopathy was defined based on prolonged prothrombin time (PT) and activated partial thromboplastin time (aPTT) in conjunction with an international normalized ratio (INR) ≥ 2. Cellulitis was diagnosed clinically at the bite site. Associations between major complications were evaluated using univariable analyses. Results: A total of 250 patients were included. Venom-induced consumption coagulopathy occurred in 69 patients (27.6%), AKI in 19 patients (7.6%), and cellulitis in 19 patients (7.6%). Acute kidney injury was more frequently observed among patients with cellulitis compared with those without cellulitis (57.9% vs. 4.4%; P = 0.005; OR = 4.10). Venom-induced consumption coagulopathy was also significantly more common in patients with AKI than in those without AKI (P = 0.005; OR = 4.10). No in-hospital mortality was observed. Conclusions: Although AKI occurred in a minority of patients with E. carinatus envenomation, it was significantly associated with coagulopathy and was more frequently observed in patients with cellulitis. These findings highlight the importance of careful monitoring for renal complications in patients presenting with major envenomation-related complications.