J Korean Soc Emerg Med.  2023 Aug;34(4):305-313.

Availability of erythrocyte sedimentation rate as a predictor of venom induced coagulopathy in patients with snakebite

• Heo H
• Moon HJ
• Shin TY
• Lee DW
• Jeong DK
• Kim HJ
• Lee HJ

Abstract

Objective
Venom-induced coagulopathy (VIC) is a common snakebite complication that can cause life-threatening hemorrhage. Previous studies have shown that snake venom can cause a decrease in the erythrocyte sedimentation rate (ESR), but this has not been investigated in actual clinical practice. This study evaluated the clinical utility of erythrocyte sedimentation rate as a predictive factor for VIC in patients with a poisonous snakebite.
Methods
From January 2012 to December 2021, this study performed a retrospective study of patients with venomous snakebites presenting to a tertiary emergency department. The demographic and laboratory data were collected through a chart review. The patients were divided into two groups, VIC and NoVIC groups. Logistic regression analysis was performed to identify the factors that predicted the presence of VIC, and the receiver operating characteristic (ROC) curve was drawn.
Results
One hundred and fifty-three patients were enrolled, and 31 patients (20.3%) developed VIC. The VIC group had significantly lower ESR than the NoVIC group (5.1±5.6 vs. 14.8±13.8; P<0.001). Logistic regression analysis showed that the decreased ESR was associated with the occurrence of coagulopathy (odds ratio, 0.957; 95% confidence interval, 0.917-0.999; P=0.045). The area under the curve was 0.701 in the ROC curve, and the cutoff value was set to 4.5 mm/hr.
Conclusion
ESR measured upon arrival at the emergency department was available to predict venom-induced coagulopathy in snakebite patients.

Keyword

Erythrocyte sedimentation; Snake bites; Diagnosis; Blood coagulation factors