Mortality Predictors of Snake Bite Envenomation in Southern India—A Ten-Year Retrospective Audit of 533 Patients

David, Suresh S.; Matathia, Sarah; Christopher, Solomon

doi:10.1007/s13181-011-0204-0

Cited by 38 publications

(42 citation statements)

References 6 publications

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“…AKI is a strong predictor of mortality among the in-hospital patients with snake bite[22,34]. Mortality of 9.1% was observed in our study.…”

Section: Discussionsupporting

confidence: 51%

Clinicopathological spectrum of snake bite-induced acute kidney injury from India

Vikrant¹,

Jaryal²,

Parashar³

2017

WJN

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AIMTo study the clinico-pathological spectrum of snake bite-induced acute kidney injury (AKI).METHODSA retrospective study of patients admitted at Indira Gandhi Medical College Hospital, Shimla with snake bite-induced AKI from July 2003 to June 2016. Medical records were evaluated for patient’s information on demographic, clinical characteristics, complications and outcome. Outcomes of duration of hospital stay, requirement for intensive care unit support, treatment with dialysis, survival and mortality were analyzed. The survival and non survival groups were compared to see the difference in the demographic factors, clinical characteristics, laboratory results, and complications. In patients subjected to kidney biopsy, the findings of histopathological examination of the kidney biopsies were also analyzed.RESULTSOne hundred and twenty-one patients were diagnosed with snake bite-induced AKI. Mean age was 42.2 ± 15.1 years and majority (58%) were women. Clinical details were available in 88 patients. The mean duration of arrival at hospital was 3.4 ± 3.7 d with a range of 1 to 30 d. Eighty percent had oliguria and 55% had history of having passed red or brown colored urine. Coagulation defect was seen in 89% patients. The hematological and biochemical laboratory abnormalities were: Anemia (80.7%), leukocytosis (75%), thrombocytopenia (47.7%), hyperkalemia (25%), severe metabolic acidosis (39.8%), hepatic dysfunction (40.9%), hemolysis (85.2%) and rhabdomyolysis (68.2%). Main complications were: Gastrointestinal bleed (12.5%), seizure/encephalopathy (10.2%), hypertension, pneumonia/acute respiratory distress syndrome (ARDS) and disseminated intravascular coagulation (9.1% each), hypotension and multi organ failure (MOF) (4.5% each). Eighty-two percent patients required renal replacement therapy. One hundred and ten (90.9%) patient survived and 11 (9.1%) patients died. As compared to the survival group, the white blood cell count (P = 0.023) and bilirubin levels (P = 0.006) were significant higher and albumin levels were significantly lower (0.005) in patients who died. The proportion of patients with pneumonia/ARDS (P = 0.001), seizure/encephalopathy (P = 0.005), MOF (P = 0.05) and need for intensive care unit support (0.001) was significantly higher and duration of hospital stay was significantly shorter (P = 0.012) in patients who died. Kidney biopsy was done in total of 22 patients. Predominant lesion on kidney biopsy was acute tubular necrosis (ATN) in 20 (91%) cases. In 11 cases had severe ATN and in other nine (41%) cases kidney biopsy showed features of ATN associated with mild to moderate acute interstitial nephritis (AIN). One patient only had moderate AIN and one had patchy renal cortical necrosis (RCN).CONCLUSIONAKI due to snake bite is severe and a high proportion requires renal replacement therapy. On renal histology ATN and AIN are common, RCN is rare.

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“…AKI is a strong predictor of mortality among the in-hospital patients with snake bite[22,34]. Mortality of 9.1% was observed in our study.…”

Section: Discussionsupporting

confidence: 51%

Clinicopathological spectrum of snake bite-induced acute kidney injury from India

Vikrant¹,

Jaryal²,

Parashar³

2017

WJN

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“…[16,18,19] One study from southern India reported acute kidney injury in 28% of snakebite patients, with a significant association with mortality. [23] …”

Section: Discussionmentioning

confidence: 99%

Classifying snakebite in South Africa: Validating a scoring system

2016

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Objective. To develop and validate a scoring system for managing snakebites in South Africa (SA). Methods. We studied all snakebite admissions to a regional hospital in KwaZulu-Natal, SA. The primary outcome was an active treatment intervention (ATI) defined as antivenom treatment or any surgical procedure. The development cohort consisted of 879 patients with snakebite who presented to the Ngwelezane Hospital Emergency Department from December 2008 to December 2013. Factors predictive of ATI and the optimal cut-off score for predicting an ATI were identified. These factors were then used to develop a standard scoring system. The score was then tested prospectively for accuracy in a new validation cohort consisting of 100 patients admitted for snakebite to our unit from 1 December 2014 to 31 March 2015. Accuracy of the score was determined. Results. Of 879 snakebite admissions, 146 in the development cohort and 40 of 100 in the development validation cohort reached the primary endpoint of an ATI. Six risk predictors for ATI were identified from the development cohort: age <14 years (odds ratio (OR) 2.13), delay to admission >7 hours (OR 4.63), white cell count >10 × 10 9 /L (OR 3.15), platelets <92 × 10 9

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“…The envenoming snake species is highly likely to influence the clinical presentation and outcome, but many studies have considered together bites from different snake species [9], [14], [26], [37], [94], [156]–[158]. Such differences are perhaps unavoidable as confirming the identity of the envenoming snake is often difficult.…”

Section: Clinical Manifestationsmentioning

confidence: 99%

Neurotoxicity in Snakebite—The Limits of Our Knowledge

2013

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Snakebite is classified by the WHO as a neglected tropical disease. Envenoming is a significant public health problem in tropical and subtropical regions. Neurotoxicity is a key feature of some envenomings, and there are many unanswered questions regarding this manifestation. Acute neuromuscular weakness with respiratory involvement is the most clinically important neurotoxic effect. Data is limited on the many other acute neurotoxic manifestations, and especially delayed neurotoxicity. Symptom evolution and recovery, patterns of weakness, respiratory involvement, and response to antivenom and acetyl cholinesterase inhibitors are variable, and seem to depend on the snake species, type of neurotoxicity, and geographical variations. Recent data have challenged the traditional concepts of neurotoxicity in snake envenoming, and highlight the rich diversity of snake neurotoxins. A uniform system of classification of the pattern of neuromuscular weakness and models for predicting type of toxicity and development of respiratory weakness are still lacking, and would greatly aid clinical decision making and future research. This review attempts to update the reader on the current state of knowledge regarding this important issue.

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Mortality Predictors of Snake Bite Envenomation in Southern India—A Ten-Year Retrospective Audit of 533 Patients

Cited by 38 publications

References 6 publications

Clinicopathological spectrum of snake bite-induced acute kidney injury from India

Clinicopathological spectrum of snake bite-induced acute kidney injury from India

Classifying snakebite in South Africa: Validating a scoring system

Neurotoxicity in Snakebite—The Limits of Our Knowledge

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