The Usefulness of Platelet Distribution Width and Platelet Distribution Width to Lymphocyte Ratio in Predicting Severity and Outcomes in Patients with Snakebite

Abstract

Introduction-Tissue damage, inflammatory response, and hematologic abnormalities may occur in snakebite envenomation. This study aimed to evaluate the predictive ability of platelet distribution width (PDW) and platelet distribution width to lymphocyte ratio (PDWLR) in the severity and outcome of envenomation in patients with snakebites in the emergency department (ED).Methods-All adult patients admitted to the ED after a snakebite were retrospectively evaluated. Patients were classified according to the severity of envenomation. The relationship between the PDW and PDWLR and envenomation severity and patient outcomes was analyzed. Multivariate logistic regression analysis was performed to determine the predictors of severe envenomation. Results were presented as 95% CIs with odds ratios. Statistical significance was accepted at P<0.05.Results-Envenomation was classified as none/minimal in 42 patients and moderate/severe in 29. PDW and PDWLR were significantly higher in the moderate/severe group (P=0.016 and P<0.001, respectively). Cut-off values of 16.5 for PDW and 6.15 for PDWLR were related to more severe envenomation (area under the curve 0.67, 95% CI 0.55-0.78 and area under the curve 0.85, 95% CI: 0.74-0.92, respectively). Blood product replacement, thrombocytopenia, hematologic abnormality, advanced local findings, compartment syndrome/fasciotomy, antivenom dosing, and moderate/ severe envenomation were associated with PDWLR >6.15 (P<0.05). In multivariate analysis, PDWLR (odds ratio 1.19 [95% CI 1-1.4]; P=0.04) was an independent predictor of severe envenomation.Conclusions-Higher PDW and PDWLR were associated with severe envenomation in patients with snakebites in the ED. PDWLR may be used as a predictor of severe envenomation and adverse outcomes.

Snakebites in Pediatric Patients in Kahramanmaraş: Is Pro-brain Natriuretic Peptide a Prognostic Biomarker for Snakebites?

“…One study in Sri Lanka showed that hemostatic dysfunction developed in 6% of patients after hump-nosed viper bites [ 18 ]. Another study in Turkey detected hematological abnormalities in 15% of the patients [ 19 ]. Coagulation disorder was detected in 25% of our patients.…”

“…Çelik et al examined scorpion stings in children and showed that increased platelet and PCT values were predictive of serious clinical conditions [ 26 ]. In another study, an increased PDW and PDW to lymphocyte ratio showed a poor prognosis in snakebites [ 19 ]. In our study, however, PCT was found to be lower in the group with serious complications and was predictive of a poor outcome.…”

Prediction of Compartment Syndrome after Protobothrops mucrosquamatus Snakebite by Diastolic Retrograde Arterial Flow: A Case Report

“…Laboratory analysis was also an effective tool to predict PSCS [ 8 , 9 ]. In a study [ 9 ], 6.6% (9/136) patients developed PSCS and the authors found a significant increase in the white blood cell (WBC) count, segment form, aspartate aminotransferase level, and alanine aminotransferase level in the PSCS group.…”

Mean platelet volume to lymphocyte ratio and platelet distribution width to lymphocyte ratio in Iraqi patients diagnosed with systemic lupus erythematosus

“…On the other hand, PDWLR has been assessed as a tool to predict the severity and risk of death in patients with snake bites, as well as cardiovascular disease risk [15,16].…”

“…The platelet distribution width to lymphocyte ratio (PDWLR), which is easily calculated by dividing the PDW by lymphocyte count, has emerged as a predictor of cardiovascular risk and severity of snakes bites [15,16]. In the literature, several studies have assessed the MPV and PDW in relation to SLE disease activity [7,[17][18][19][20][21][22].…”