Outcomes of venom-induced consumption coagulopathy following snakebite envenoming in Sudan: a cohort study.

BACKGROUND: Snakebite envenomation (SBE) is a major neglected tropical diseases, causing significant morbidity and mortality, particularly in sub-Saharan Africa. Venom-induced consumption coagulopathy (VICC) is a major systemic complication and leading cause of death in haemotoxic snakebite. In Sudan, SBE is underreported, and data on VICC in resource-limited settings remain scarce. This study aimed to determine the incidence, clinical and laboratory characteristics, management, and in-hospital outcomes of VICC in SBE patients, and to evaluate the performance of the 20-min whole blood clotting test (WBCT20) as a bedside screening tool. METHODS: A hospital-based observational cohort study was conducted at Sinja Teaching Hospital, Sudan (15 March-15 September 2022). All consecutive SBE patients were included (n = 119). VICC was defined as INR ≥ 1.4 with prolonged PT and/or APTT. Data were collected using a structured questionnaire and routine clinical records. All patients underwent WBCT20 and standard coagulation testing. Outcomes included in-hospital mortality, acute kidney injury (AKI), severe haemorrhage, and length of stay. Analysis was descriptive using SPSS v25. RESULTS: Of 119 patients, 96 (80.7%) developed VICC. Most were young male farmers with lower limb bites (88.2%). Suspected Echis spp. accounted for 86.6% of cases. Spontaneous bleeding occurred in 88.5% of VICC patients, and severe haemorrhage in 30.2%, most commonly intracerebral bleeding. AKI occurred in 29.4% of all patients and only in those with VICC. WBCT20 was positive in all VICC cases (sensitivity 100%) and showed specificity of 89.6%, with 10 cases positive despite INR < 1.5, suggesting early coagulopathy. In-hospital mortality among VICC patients was 30.2%. All VICC patients received fresh frozen plasma, with clinical and laboratory improvement in 69.8%, though no comparative efficacy analysis was performed. CONCLUSIONS: VICC is highly prevalent among hospitalized SBE patients in this setting and is associated with major complications and high mortality. WBCT20 is a sensitive bedside tool but requires confirmation with laboratory testing. Findings highlight gaps in antivenom coverage, the need for species-appropriate therapy, and strengthened surveillance and prospective studies to improve snakebite management in Sudan.