Evaluating Urine Protein-creatinine Ratio in Snakebite Patients and Its Relationship to Clinical Outcomes: An Observational Study

Background: Snakebite envenomation, particularly from haemotoxic and myotoxic species, such as Russell's viper and saw-scaled viper, poses a significant public health challenge in tropical and subtropical regions.Acute kidney injury (AKI), a common and life-threatening complication of snakebites, is associated with tubular and cortical necrosis.This study aimed to evaluate the urine protein-to-creatinine ratio (UPCR) as a marker of renal involvement and its relationship with clinical outcomes in patients with snakebites.Materials and methods: A prospective observational study was conducted on 46 snakebite patients admitted to the Emergency Department of a tertiary-care hospital in India over an 18-month period.Patients were administered polyvalent anti-snake venom, and clinical data, including UPCR 18 months, envenomation severity, laboratory parameters, and outcomes, were recorded.Statistical associations were analysed using SPSS version 21.0, with p < 0.05 considered significant. Results:The study included 46 patients with a mean age of 37.85 10.24 years.Pain and tenderness were present in 91.3% of patients, swelling in 54.3%, and haematotoxicity in 58.7%.A UPCR > 0.3 was observed in 15.2% of patients and was significantly associated with longer hospital stays (median: 5 vs 2 days, p = 0.009), higher ICU admission rates (57.1 vs 2.6%, p < 0.0001), and increased mortality (28.6 vs 0%, p = 0.001).Acute kidney injury occurred in 10.9% of the patients, and neurotoxicity was observed in 8.7%.The overall mortality rate was 4.3%.Conclusion: Elevated UPCR levels were significantly associated with adverse clinical outcomes, including prolonged hospitalisation, ICU admission, and mortality, reflecting its role as a marker of renal involvement and systemic complications.