O papel da ultrassonografia pulmonar e cardíaca à beira leito (PoCUS) e de biomarcadores na avaliação de gravidade do acidente escorpiônico

Abstract

Introduction: Scorpion envenomation represent a world public health problem, especially in tropical regions. At João XXIII hospital, in Belo Horizonte, Minas Gerais, an average of 1,500 cases of scorpionism are treated per year, with about 3% of them considered severe. The early identification of the risk of complications can have a favorable impact on the prognosis of the victims, but objective tools are lacking to define this risk. Objectives: This study aims to investigate the role of cardiac and pulmonary ultrasound and serum biomarkers as tools for characterizing the severity, defined by the need for admission to an intensive care unit (ICU), in cases of scorpionism. Material and methods: Cross-sectional observational study, which included patients under 19 years of age, treated at a reference hospital, from December 2020 to May 2022, with a report of a scorpion sting moderate or severe. All research subjects underwent laboratory tests, simple chest radiography and electrocardiogram, in addition to bedside cardiac and pulmonary ultrasound (POCUS). At least one aliquot of plasma was separated from each participant for later measurement of cardiac and inflammatory biomarkers. Results: Forty-nine patients were included in the study during 18 months. Regarding the clinical classification, 83,7% (41) were classified as. The most frequent clinical manifestations were vomiting (90.2%) and tachypnea (74.5%). 54.9% of cases (28 patients) were admitted in ICU. Some degree of left ventricular dysfunction was identified in 13 patients (26.5%). In addition, pulmonary congestion on was observed in 10 patients (20.4%). There was an association between LV dysfunction and pulmonary congestion on POCUS with the need for ICU admission (OR 15 (95% CI 1.759- 127.913, p=0.013) and OR 9.474 (95% CI 1.093-82.089 p=0.041), respectively). Serum levels of troponin I (p=0.016) and galectin 3 (p=0.037) were significantly higher in patients admitted to the ICU. Discussion and conclusion: Pulmonary and cardiac POCUS victims of scorpion stings were shown to be associated with the need for ICU admission, and can become a useful tool for the objective selection of case referrals to this sector. Serum troponin I and galectin 3 were also able to identify these patients.