Predictive Factors for Death After Snake Envenomation in Myanmar

Introduction: Factors predictive for death from snake envenomation vary between studies, possibly due to variation in host genetic factors and venom composition. This study aimed to evaluate predictive factors for death from snake envenomation in Myanmar. Methods: A prospective study was performed among adult patients with snakebite admitted to tertiary hospitals in Yangon, Myanmar, from May 2015 to August 2016. Data including clinical variables and laboratory parameters, management, and outcomes were evaluated. Multivariate regression analysis was performed to evaluate factors predictive for death at the time of presentation to the hospital. Results: Of the 246 patients with snake envenomation recruited into the study, 225 (92%) survived and 21 (8%) died during hospitalization. The snake species responsible for a bite was identified in 74 (30%) of the patients; the majority of bites were from Russell's vipers (63 patients, 85%). The independent factors predictive for death included 1) duration from bite to arrival at the hospital >1 h (odds ratio [OR]: 9.0, 95% confidence interval [CI]: 1.1–75.2; P=0.04); 2) white blood cell counts >20 ×10³ cells·μL^-1 (OR: 8.9, 95% CI: 2.3–33.7; P=0.001); and 3) the presence of capillary leakage (OR: 3.7, 95% CI: 1.2–11.2; P=0.02). A delay in antivenom administration >4 h increases risk of death (11/21 deaths). Conclusions: Patients who present with these independent predictive factors should be recognized and provided with early appropriate intervention to reduce the mortality rate among adults with snake envenomation in Myanmar.