PREDICTORS OF IN-HOSPITAL MORTALITY IN PATIENTS WITH SNAKE BITE IN POPULATION OF KARACHI, PAKISTAN

Harish Kumar, Adnan Bashir, Khadijah Abid, Nabeel Naeem Baig

Abstract


Background: Snake bite remains major public health problems worldwide. The objective of this study was to determine predictors of in-hospital mortality in patients presenting with snake bite in population of Karachi, Pakistan.
Materials & Methods: It was cross-sectional study conducted at Department of General Medicine, Postgraduate Medical Center, Karachi, Pakistan from 11th June 2016 to 10th August 2017. 300 patients with snake bite were selected. Age, gender, acute kidney injury, vomiting and in-hospital mortality were variables. Except age, all variables were nominal and were analyzed by frequency and percentage. Cox-proportional-hazard regression model was applied and hazard ratios were calculated along with 95% confidence intervals (CI) to assess the strength of association between predictors i.e. age, gender, AKI and vomiting and outcome (in-hospital mortality). Kaplan-Meier and time to event plot were used to investigate all patients who were on follow-up for 7 days from admission. Log-rank test was used to identify the predictors of in-hospital mortality for significant independent influence on prognosis at alpha .05.
Results: The mean age of the sample was 27.7±14.58 years. Out of a sample of 300 patients, 221 (73.7%) were males and 79 (26.3%) females. The frequency (%) of AKI was 102 (66%), vomiting 122 (40.7%) and of in-hospital mortality 31 (10.3%). The probability of survival at day 7 was 81.8%. Vomiting [hazard ratio 6.86 (95% CI: 2.78-16.93), p=<0.001] and acute kidney injury [hazard ratio 3.85 (95% CI: 1.75-8.45), p=<0.001] were associated with higher risk of death in adjusted analysis.
Conclusion: Acute kidney injury and vomiting are strong predictors of mortality among patients with snake bite. These predictors can be helpful for clinicians in assessing prognosis of their patients more accurately and by early management of these factors, mortality & morbidity can be reduced.

Keywords


Snake Bites; Acute Kidney Injury; Mortality; Vomiting; Risk factors; Survival; Antivenoms; Poisoning.

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References


WHO. Venomous snakes distribution and species risk categories. Available At: https://apps.who.int/bloodproducts/snakeantivenoms/database/default.htm

WHO. Snakebite envenoming: World Health Organization; 2019 [cited 2018 May 10]. Available from: https://www.who.int/news-room/fact-sheets/detail/snakebite-envenoming.

Mohapatra B, Warrell DA, Suraweera W, Bhatia P, Dhingra N, Jotkar RM, et al. Snakebite mortality in India: a nationally representative mortality survey. PLoS Negl Trop Dis 2011;5(4):e1018. https://doi.org/10.1371/journal.pntd.0001018

Brunda G, Sashidhar RB. Epidemiological profile of snake-bite cases from Andhra Pradesh using immunoanalytical approach. Indian J Med Res 2007; 125(5): 661-8.

Meenatchisundaram S, Michael A. Snake bite and therapeutic measures: Indian scenario. Indian J Sci Technol 2009; 2(10): 69-73. https://doi.org/10.17485/ijst/2009/v2i10.17

Cesaretli Y, Ozkan O. Snakebites in Turkey: epidemiological and clinical aspects between the years 1995 and 2004. J Venom Anim Toxins Incl Trop Dis 2010; 16(4):579-86. https://doi.org/10.1590/S1678-91992010000400007

Ahmed SM, Nadeem A, Islam MS, Agarwal S, Singh L. Retrospective analysis of snake victims in Northern India admitted in a tertiary level institute. J Anaesthesiol Clin Pharmacol 2012;28(1):45-50. https://doi.org/10.4103/0970-9185.92434

Monteiro FN, Kanchan T, Bhagavath P, Kumar GP, Menezes RG, Yoganarasimha K. Clinico-epidemiological features of viper bite envenomation: a study from Manipal, South India. Singapore Med J 2012; 53(3): 203-7.

Patil HV, Patil A, Agrawal V. Clinical profile and outcome of envenomous snake-bite at tertiary care centre in western Maharashtra. Int J Med Public Health 2011;1(4): 28-8. https://doi.org/10.5530/ijmedph.4.2011.7

Sharma SK, Khanal B, Pokhrel P, Khan A, Koirala S. Snakebite-reappraisal of the situation in Eastern Nepal. Toxicon 2003;41(3):285-9. https://doi.org/10.1016/S0041-0101(02)00289-1

Chew KS, Khor HW, Ahmad R, Rahman NHNA. A five-year retrospective review of snakebite patients admitted to a tertiary university hospital in Malaysia. Int J Emerg Med 2011; 4(1): 41. https://doi.org/10.1186/1865-1380-4-41

Chandio AM, Sandelo P, Rahu AA, Ahmed S, Dahri AH, Bhatti R. Snake bite: Treatment seeking behaviour among Sindh rural population. J Ayub Med Coll Abbottabad 2000;12(3):3-5.

Kalantri S, Singh A, Joshi R, Malamba S, Ho C, Ezoua J, et al. Clinical predictors of in-hospital mortality in patients with snake bite: a retrospective study from a rural hospital in central India. Trop Med Int Health 2006; 11(1): 22-30. https://doi.org/10.1111/j.1365-3156.2005.01535.x

Kulkarni ML, Anees S. Snake venom poisoning: experience with 633 cases. Indian Pediatr 1994; 31(10): 1239-43.

Bawaskar HS, Bawaskar PH, Punde DP, Inamdar MK, Dongare RB, Bhoite RR. Profile of snakebite envenoming in rural Maharashtra, India. J Assoc Physicians India 2008; 56: 88-95.

Lavonas EJ, Tomaszewski CA, Ford MD, Rouse AM, Kerns WP, 2nd. Severe puff adder (Bitis arietans) envenomation with coagulopathy. J Toxicol Clin Toxicol 2002; 40(7): 911-8. https://doi.org/10.1081/CLT-120016963

Ali G, Kak M, Kumar M, Bali S, Tak S, Hassan G, et al. Acute renal failure following echis carinatus (saw-scaled viper) envenomation. Indian J Nephrol 2004; 14: 177-81.

Patil T, Bansod Y. Snake bite-induced acute renal failure: A study of clinical profile and predictors of poor outcome. Ann Trop Med Public Health 2012; 5(4): 335-9. https://doi.org/10.4103/1755-6783.102046

Athappan G, Balaji MV, Navaneethan U, Thirumalikolundusubramanian P. Acute renal failure in snake envenomation: a large prospective study. Saudi J Kidney Dis Transpl 2008; 19(3): 404-10.

Kularatne SA. Common krait (Bungarus caeruleus) bite in Anuradhapura, Sri Lanka: a prospective clinical study, 1996-98. Postgrad Med J 2002; 78(919): 276-80. https://doi.org/10.1136/pmj.78.919.276




DOI: https://doi.org/10.46903/gjms/17.04.1861

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