Liu Yong, Shu Hongmei, Long Youlin, Nie Xiaoqin, Tang Hongfu, Tu Lang, Zhang Hao, Qiu Gang, He Daihua, Huang Qiang, Zhang Qi, Qing Shuang, Xu Donglin, Xia Hongtao
Department of Critical Care Medicine, Suining Central Hospital, An Affiliated Hospital of Chongqing Medical University, An Affiliated Hospital of North Sichuan Medical College, Suining, Sichuan Province, China.
Chinese Evidence-Based Medicine Center, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China.
Clin Kidney J. 2021 Oct 7;15(2):320-327. doi: 10.1093/ckj/sfab201. eCollection 2022 Feb.
In recent years, the incidence of wasp sting has increased annually in China. Organ damage and high mortality due to mass wasp envenomation remain major challenges. Timely and appropriate medical intervention can improve survival. However, there are currently no normalized tools for early assessment of severity.
The clinical data of wasp sting patients hospitalized from 2011 to 2019 were used as a training set. Logistic regression was used to explore major risk factors for the development of a severe case of wasp sting (SC). The Wasp Sting Severity Score (WSS) was determined considering these risk factors to identify SCs and was tested in a validation dataset that was prospectively collected in 2020.
The data of 1131 wasp sting patients from 2011 to 2019 were included in the training set. Logistic regression analysis showed that tea-colored urine, number of stings, and lactate dehydrogenase and total bilirubin levels were risk factors for developing an SC. The WSS was developed considering these four risk factors, and the total possible WSS was 20 points. The WSS was tested using the validation dataset, comprising the data of 153 patients, in 2020, and we found that a WSS ≥3 points was an important indication for blood purification, with a sensitivity of 71.9%, specificity of 92.6% and an area under the curve of 0.918 (95% confidence interval 0.873-0.962). Among patients with more than 30 stings, mortality in those who underwent plasma exchange (PE) within 24 h after admission was significantly lower than that in those who did not receive PE treatment (14.3% versus 46.9%, P = 0.003). However, continuous venovenous hemofiltration (CVVH) (P = 0.317) and hemoperfusion (HP) (P = 0.869) did not significantly reduce mortality.
Patients with WSS scores ≥3 should be considered for blood purification as early as possible in addition to routine treatment. In addition, PE is better than CVVH and HP at reducing mortality in patients suffering from severe wasp stings.
近年来，中国黄蜂蜇伤的发病率逐年上升。大量黄蜂蜇伤导致的器官损伤和高死亡率仍然是主要挑战。及时、恰当的医疗干预可提高生存率。然而，目前尚无标准化的早期严重程度评估工具。
将2011年至2019年住院的黄蜂蜇伤患者的临床数据作为训练集。采用逻辑回归分析探讨黄蜂蜇伤重症病例（SC）发生的主要危险因素。综合考虑这些危险因素确定黄蜂蜇伤严重程度评分（WSS）以识别SC，并在2020年前瞻性收集的验证数据集中进行检验。
训练集纳入了2011年至2019年1131例黄蜂蜇伤患者的数据。逻辑回归分析显示，茶色尿、蜇伤次数、乳酸脱氢酶和总胆红素水平是发生SC的危险因素。综合这四个危险因素制定了WSS，WSS总分可能为20分。2020年使用包含153例患者数据的验证数据集对WSS进行检验，发现WSS≥3分是血液净化的重要指征，敏感性为71.9%，特异性为92.6%，曲线下面积为0.918（95%置信区间0.873 - 0.962）。在蜇伤超过30次的患者中，入院后24小时内接受血浆置换（PE）的患者死亡率显著低于未接受PE治疗的患者（14.3%对46.9%，P = 0.003）。然而，持续静脉 - 静脉血液滤过（CVVH）（P = 0.317）和血液灌流（HP）（P = 0.869）并未显著降低死亡率。
除常规治疗外，WSS评分≥3分的患者应尽早考虑血液净化治疗。此外，在降低重度黄蜂蜇伤患者死亡率方面，PE优于CVVH和HP。
