title: Clinical predictors of in-hospital mortality in patients with snake bite: a retrospective study from a rural hospital in central India.
abstract: 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 < 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.
  
  
  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.
authors.affiliation: Department of Medicine, Mahatma Gandhi Institute of Medical Sciences, Sevagram, India. sp.kalantri@gmail.com
authors.forename: Shriprakash
authors.initials: S
authors.lastname: Kalantri
authors.forename: Amandeep
authors.initials: A
authors.lastname: Singh
authors.forename: Rajnish
authors.initials: R
authors.lastname: Joshi
authors.forename: Samuel
authors.initials: S
authors.lastname: Malamba
authors.forename: Christine
authors.initials: C
authors.lastname: Ho
authors.forename: Joseph
authors.initials: J
authors.lastname: Ezoua
authors.forename: Maureen
authors.initials: M
authors.lastname: Morgan
mesh_terms: D000293:Adolescent; D000328:Adult; D000419:Albuminuria / Q000453:epidemiology / Q000209:etiology; D000704:Analysis of Variance; D002648:Child; D003404:Creatinine / Q000097:blood; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007194:India / Q000453:epidemiology; D008297:Male; D020258:Neurotoxicity Syndromes / Q000453:epidemiology / Q000209:etiology; D012189:Retrospective Studies; D012307:Risk Factors; D012423:Rural Health; D012909:Snake Bites / Q000150:complications / Q000401:mortality*; D014839:Vomiting / Q000453:epidemiology / Q000209:etiology
chemical_list: D003404:Creatinine