독사 교상 환자의 응급실 초기 검사에 따른 예후 예측 인자
Prognostic Predictors of Outcome in Patients with Snake Bite, Based on Initial Findings in the Emergency Department
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Purpose: This study was conducted to identify predictors of serious poisoning in patients with snake bite based on initial findings. Methods: We conducted a retrospective study of patients with snake bite who were treated at the emergency department between January 2010 and December 2016. The patients were divided into two groups according to the severity of symptoms based on the traditional snakebite severity grading scale. The mild poisoning group (MP) was classified as those who had a grade I snakebite severity during the hospital stay, and the severe poisoning group (SP) was classified as patients who had grade I at the time of admission, but progressed to grade II-IV during hospitalization. Initial clinical manifestations and laboratory findings of the two groups were compared. Results: Bite to hospital time intervals of SP were longer than those of MP (p=0.034), and the local effect score (LES) was higher in SP (p<0.001). Laboratory analyses revealed that creatine phosphokinase (p=0.044), creatine phosphokinase MB isoenzyme (CK-MB, p=0.011) and serum amylase (p=0.008) were significantly higher in SP. LES, CK-MB and serum amylase were significant prognostic predictors as indicated by univariate logistic regression analysis. Multivariate analysis revealed the following two significant predictors: LES (odds ratio=3.983, p<0.001) and serum amylase (odds ratio=1.020, p=0.017). Conclusion: In managing cases of snake bites, clinical manifestations and laboratory findings must be carefully evaluated. LES and serum amylase are predictive factors for severe poisoning, which is especially important to rapid determination of the intensive care of the patient.
Abstract
Purpose: This study was conducted to identify predictors of serious poisoning in patients with snake bite based on initial findings. Methods: We conducted a retrospective study of patients with snake bite who were treated at the emergency department between January 2010 and December 2016. The patients were divided into two groups according to the severity of symptoms based on the traditional snakebite severity grading scale. The mild poisoning group (MP) was classified as those who had a grade I snakebite severity during the hospital stay, and the severe poisoning group (SP) was classified as patients who had grade I at the time of admission, but progressed to grade II-IV during hospitalization. Initial clinical manifestations and laboratory findings of the two groups were compared. Results: Bite to hospital time intervals of SP were longer than those of MP (p=0.034), and the local effect score (LES) was higher in SP (p<0.001). Laboratory analyses revealed that creatine phosphokinase (p=0.044), creatine phosphokinase MB isoenzyme (CK-MB, p=0.011) and serum amylase (p=0.008) were significantly higher in SP. LES, CK-MB and serum amylase were significant prognostic predictors as indicated by univariate logistic regression analysis. Multivariate analysis revealed the following two significant predictors: LES (odds ratio=3.983, p<0.001) and serum amylase (odds ratio=1.020, p=0.017). Conclusion: In managing cases of snake bites, clinical manifestations and laboratory findings must be carefully evaluated. LES and serum amylase are predictive factors for severe poisoning, which is especially important to rapid determination of the intensive care of the patient.
참고문헌 (28)
- "Geneva: Venomous snakes distribution and species risk categories" (2013)[URL]
- Shim JH, "Ecological study on poisonous snake and investigation of the venom characteristics, snakebiting frequency in Korea", Korean J Environ Ecol, 12, pp.58~77 (1998)
- Warrell DA., "Snake bite", Lancet, 375, pp.77~88 (2010)
- Hifumi T, "Venomous snake bites: clinical diagnosis and treatment", J Intensive care, 3, pp.16~20 (2015)
- 유경민, "경증과 무증상을 보이는 독사 교상 환자의 항독사혈청 치료용량의 제안", 대한응급의학회지, 24(4), pp.420~427 (2013), 대한응급의학회
- Peterson ME, "Snake bite: pit vipers", Clin Tech Small Anim Pract, 21, pp.174~182 (2006)
- Dart RC, "Validation of a severity score for the assessment of crotalid snakebite", Ann Emerg Med, 27, pp.321~326 (1996)
- Scharman EJ, "Copperhead snakebites:clinical severity of local effects", Ann Emerg Med, 38, pp.55~61 (2001)
- Ozay G, "Clinical characteristics of children with snakebite poisoning and management of complications in the pediatric intensive care unit", Pediatr Int, 47, pp.669~675 (2005)
- Moss ST, "Association of rattlesnake bite location with severity of clinical manifestations", Ann Emerg Med, 30, pp.58~61 (1997)
- 진상찬, "독사 교상 환자에서 전신 증상 및 합병증 발생에 연관된 인자에 대한 연구", 대한응급의학회지, 19(6), pp.686~696 (2008), 대한응급의학회
- Sajevic T, "Haemostatically active proteins in snake venoms", Toxicon, 57, pp.627~645 (2011)
- 임훈, "한국 뱀 교상에 대한 항뱀독소", 대한의사협회지, 56(12), pp.1091~1103 (2013), 대한의사협회
- Hifumi T, "Clinical efficacy of antivenom and cepharanthine for the treatment of Mamushi (Gloydius blomhoffii) bites in tertiary care centers in Japan", Jpn J Infect Dis, 66, pp.26~31 (2013)
- Huerta-Alardin AL, "Bench-to-bedside review: Rhabdomyolysis - an overview for clinicians", Crit Care, 9, pp.158~169 (2005)
- Keltz E, "Rhabdomyolysis. The role of diagnostic and prognostic factors", Muscles Ligaments Tendons J, 3, pp.303~312 (2014)
- Carroll RR, "Canebrake rattlesnake envenomation", Ann Emerg Med, 30, pp.45~48 (1997)
- 강승오, "전통적 독사 교상 중증도 평가 척도 이용 시 항독소 재투여 예측 인자", 대한응급의학회지, 27(3), pp.272~279 (2016), 대한응급의학회
- Hara I, "Treatment of crush syndrome patients following the great Hanshin earthquake", Int J Urol, 4, pp.202~205 (1997)
- Buchman AL, "Total serum amylase but not lipase correlates with measured glomerular filtration rate", J Clin Gastroenterol, 16, pp.204~206 (1993)
- Pezzilli R, "Serum pancreatic enzyme concentrations in chronic viral liver diseases", Dig Dis Sci, 44, pp.350~355 (1999)
- Valenta J, "Acute pancreatitis after viperid snake cerastes cerastes envenoming: a case report", Prague Med Rep, 111, pp.69~75 (2010)
- Malkarnekar S, "A rare case of acute pancreatitis following snake envenomation with fatal outcome", Trop J Med Res, 17, pp.137~139 (2014)
- Seelig R, "The possible role of serum complement system in the formal pathogenesis of acute pancreatitis II. Cobra venom factor pancreatitis: Sodiumtaurocholate and deoxycholate pancreatitis", Acta Hepatogastroenterol (Stuttg), 22, pp.335~346 (1975)
- 이병준, "한국 독사교상의 혈액응고장애 특성 및 항사독소 사용의 효율성", 대한외과학회지, 72(1), pp.18~26 (2007), 대한외과학회
- 나중호, "Snakebite in Korea: A Guideline to Primary Surgical Management", Yonsei Medical Journal, 56(5), pp.1443~1448 (2015), 연세대학교의과대학[DOI]
- Kim DH, "Clinical significance of delayed re-evaluation in initial symptoms following snakebite injuries", J Korean Soc Clin Toxicol, 7, pp.97~104 (2009)
- 한상균, "경한 국소증상을 호소하는 독사 교상 환자에서의 항독소 사용의 효율성", 대한응급의학회지, 18(6), pp.577~583 (2007), 대한응급의학회