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Clinical predictors of in-hospital mortality in patients with snake bite
Trop Med Int Health. 2006 Jan;11(1):22-30. Related Articles, Links
Clinical predictors of in-hospital mortality in patients with snake bite: a
retrospective study from a rural hospital in central India.
Kalantri S, Singh A, Joshi R, Malamba S, Ho C, Ezoua J, Morgan M.
Department of Medicine, Mahatma Gandhi Institute of Medical Sciences,
Sevagram, India.
Objective To determine the association between selected admission risk
factors and in-hospital mortality in patients admitted with venomous snake
bite to a rural tertiary care hospital in central India. Methods
Retrospective cohort study of patients aged 12 years or older admitted to a
rural hospital in central India between January 2000 and December 2003 with
venomous snake bites. The primary endpoint was in-hospital mortality. We
used Cox proportional-hazards regression analysis to evaluate the
association between risk factors (home-to-hospital distance,
bite-to-hospital time, vomiting, neurotoxicity, urine albumin, serum
creatinine concentration and whole-blood clotting time) and in-hospital
mortality. Results Two hundred and seventy-seven patients [mean age 32 (SD
12) years; 188 men (68%)] were admitted with venomous snake bite, 29
patients (11%) died. The probability of survival at day 7 was 83%. Vomiting
[hazard ratio 6.51 (95% CI 1.94-21.77), P
ratio 3.15 (95% CI 1.45-6.83), P = 0.004] and admission serum creatinine
concentration [hazard ratio 1.35 (95% CI 1.17-1.56), P
associated with higher risk of death in the adjusted analysis. Conclusions
In our rural hospital setting, the overall mortality rate was 11 per 100
cases of snake bite. Vomiting, neurotoxicity and serum creatinine are
significant predictors of mortality among inpatients with snake bite. These
predictors can help clinicians assess prognosis of their patients more
accurately and parsimoniously and also serve as useful signposts for
clinical decision-making.
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