Kalantri Shriprakash, Singh Amandeep, Joshi Rajnish, Malamba Samuel, Ho Christine, Ezoua Joseph, Morgan Maureen
Department of Medicine, Mahatma Gandhi Institute of Medical Sciences, Sevagram, India.
Trop Med Int Health. 2006 Jan;11(1):22-30. doi: 10.1111/j.1365-3156.2005.01535.x.
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.
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.
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 < or = 0.002], neurotoxicity [hazard 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 < or = 0.001] were associated with higher risk of death in the adjusted analysis.
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.
确定印度中部一家农村三级护理医院收治的毒蛇咬伤患者所选入院风险因素与院内死亡率之间的关联。
对2000年1月至2003年12月期间收治于印度中部一家农村医院、年龄在12岁及以上的毒蛇咬伤患者进行回顾性队列研究。主要终点是院内死亡率。我们使用Cox比例风险回归分析来评估风险因素（从家到医院的距离、咬伤至入院时间、呕吐、神经毒性、尿白蛋白、血清肌酐浓度和全血凝血时间）与院内死亡率之间的关联。
277例患者[平均年龄32（标准差12）岁；188例男性（68%）]因毒蛇咬伤入院，29例患者（11%）死亡。第7天的生存概率为83%。在多因素分析中，呕吐[风险比6.51（95%可信区间1.94 - 21.77），P≤0.002]、神经毒性[风险比3.15（95%可信区间1.45 - 6.83），P = 0.004]和入院时血清肌酐浓度[风险比1.35（95%可信区间1.17 - 1.56），P≤0.001]与死亡风险较高相关。
在我们的农村医院环境中，每100例蛇咬伤病例的总体死亡率为11%。呕吐、神经毒性和血清肌酐是蛇咬伤住院患者死亡率的重要预测因素。这些预测因素可帮助临床医生更准确、更简洁地评估患者的预后，也可作为临床决策的有用指标。
