The Clinical Significance of C-Reactive Protein in Patients with <i>Gloydius blomhoffii</i> Bite

Abstract

We retrospectively investigated the clinical significance of measuring the level of C-reactive protein (CRP) level in patients with mamushi (Gloydius blomhoffii) bites to differentiate it from bacterial cellulitis. Methods: We retrospectively conducted a medical chart review of all patients with mamushi bites who were treated in our department between July 2013 and August 2017. The patients were divided into two groups: the CRP-negative group included patients whose CRP levels were within the normal limit (< 0.3 mg/dl) during hospitalization, while the CRP-positive group included patients whose CRP levels were over the normal limit (≥0.3 mg/dl) during hospitalization. Results: Thirty-five cases were examined in this study. Seventeen patients were classified into the CRP-negative group and 18 were classified into the CRP-positive group. Only 2 of the patients (5%) had a positive CRP level on arrival. There were no significant differences in sex, ratio of delayed arrival, anti-venom administration, antibiotic administration, grade of mamushi bite on arrival and maximum grade of mamushi bite, ratio of increase in CRP over the normal limit, duration of hospitalization, or mortality rate between the two groups. However, the CRP-negative group tended to be younger than the CRP-positive group. Conclusion: This is the first report to show that 5% of mamushi bite cases had a positive CRP level on arrival, and that half had a positive CRP level during hospitalization. Future prospective studies involving a greater number of patients are needed in order to determine whether or not a lack of an increase in the CRP level on arrival is a useful biomarker for differentiating between mamushi bites and cellulitis.