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Background: Macroscopic hematuria after wasp sting has been reported in Asia to occur before acute kidney injury (AKI), and is often used by clinicians as a sign indicating the need for intensive care and blood purification therapy. However, there is no study on the clinical characteristics and prognosis of this symptom. Methods: The clinical data of 363 patients with wasp sting admitted to Suining Central Hospital from January 2016 to December 2018 were retrospectively analyzed. At admission, the poisoning severity score (PSS) was used as the criterion for severity classification. According to the presence of macroscopic hematuria, the patients were divided into macroscopic hematuria and nonmacroscopic hematuria group. Results: Of the 363 wasp sting patients, 219 were male and 144 were female, with a mean age of 55.9 ± 16.3 years. Fifty-one (14%) had macroscopic hematuria, 39 (10.7%) had AKI, 105 (28.9%) had rhabdomyolysis, 61 (16.8%) had hemolysis, 45 (12.4%) went on to received hemodialysis, and 14 (3.9%) died. The incidence of AKI in macroscopic hematuria group was 70.6%, and oliguric renal failure accounted for 72.2%. Patients with macroscopic hematuria had significantly higher PSS (2.2 ± 0.5 vs. 1.1 ± 0.3, p < .001). Conclusion: Macroscopic hematuria can be regarded as a surrogate marker of deteriorating clinical outcome following wasp stings. In wasp sting patients with symptoms of macroscopic hematuria or serum LDH higher than 463.5 u/L upon admission, the risk of AKI increases significantly, therefore hemodialysis should be considered. The PSS is helpful in early assessment of the severity of wasp sting patients.

Rationale: Although coronavirus disease 2019 (COVID-19) remains a global threat, administering effective and safe vaccines is currently the most promising strategy to curb the ongoing pandemic and decrease the number of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections. However, there remains some uncertainty regarding the safety of vaccines for patients with kidney disease. Patient concerns: A 58-year-old man presented at our institution with gross hematuria 48 hours after receiving his first dose of the CoronaVac (Sinovac) vaccine. Diagnoses: Analysis of a renal biopsy sample led to the diagnosis of crescentic immunoglobulin A nephropathy (IgAN), which we considered an adverse event of receiving the CoronaVac vaccine in China. Interventions: The patient’s serum creatinine and albumin levels were 1.20 mg/dL and 31.3 g/L, respectively; as such, he was administered a diuretic. His serum creatinine level had risen to 7.45 mg/dL 1 month later, and he developed high blood pressure. The patient then received conventional doses of hormone therapy but developed recurrent fever, which led to the suspicion of active tuberculosis (which he had a history of) and suspension of the hormone therapy. Outcomes: The patient’s renal function deteriorated further, and he ultimately underwent dialysis. Lessons: The patient’s course of events of apparent IgAN exacerbation should prompt nephrologists to closely follow patients with glomerular disease after they receive a COVID-19 vaccine, especially if persistent gross hematuria occurs.

Background: We aimed to assess the utility of the poisoning severity score (PSS) as early prognostic predictors in patients with wasp stings, and to explore a reliable and simple predictive tool for short-term outcomes.Methods: From January 2016 to December 2018, 363 patients with wasp stings in Suining Central Hospital were taken as research subjects. In the first 24h of hospital admission, the PSS and Chinese expert consensus on standardized diagnosis and treatment of wasp stings (CECC) were used as the criterion for severity classification, and their correlation was analyzed. The patients were divided into survival and death groups according to the state of discharge. The factors that affect outcome were analyzed by logistic regression analysis. A clinical prognostic model of death was constructed according to the risk factors, and 1000 times repeated sampling was done to include the data to verify the model internally.Results: The mortality of wasp sting patients was 3.9%. There was a correlation between PSS and CECC (r=0.435, P<0.001) for severity classification. Sex, age, number of stings, and PSS were independent risk factors for death. Based on the 4 independent risk factors screened by the above regression analysis, a nomogram model was constructed to predict the risk of death in wasp sting patients. The predicted value C-index was 0.962, and the internally verified AUC was 0.962(95%C.I. 0.936-0.988, P<0.001).Conclusions: PSS is helpful in the early classification of the severity of wasp stings. Sex, age, number of stings, and PSS were independent risk factors for death in wasp sting patients. The nomogram model established in this study can accurately predict the occurrence of the risk of death.

Background We aimed to assess the utility of the poisoning severity score (PSS) as early prognostic predictors in patients with wasp stings, and to explore a reliable and simple predictive tool for short-term outcomes. Methods From January 2016 to December 2018, 363 patients with wasp stings in Suining Central Hospital were taken as research subjects. In the first 24h of hospital admission, the PSS and Chinese expert consensus on standardized diagnosis and treatment of wasp stings (CECC) were used as the criterion for severity classification, and their correlation was analyzed. The patients were divided into survival and death groups according to the state of discharge. The factors that affect outcome were analyzed by logistic regression analysis. A clinical prognostic model of death was constructed according to the risk factors, and 1000 times repeated sampling was done to include the data to verify the model internally. Results The mortality of wasp sting patients was 3.9%. There was a correlation between PSS and CECC (r=0.435, P<0.001) for severity classification. Sex, age, number of stings, and PSS were independent risk factors for death. Based on the 4 independent risk factors screened by the above regression analysis, a nomogram model was constructed to predict the risk of death in wasp sting patients. The predicted value C-index was 0.962, and the internally verified AUC was 0.962(95%C.I. 0.936-0.988, P<0.001). Conclusions PSS is helpful in the early classification of the severity of wasp stings. Sex, age, number of stings, and PSS were independent risk factors for death in wasp sting patients. The nomogram model established in this study can accurately predict the occurrence of the risk of death.