The Effect of Neutrophil/Lymphocyte Ratio and Mean Platelet Volume on the use of Antivenom in Snake Bites and Scorpion Stings

Yıl 2023, , 196 - 200, 01.11.2023

Mehmet Nur Talay , Özhan Orhan

https://doi.org/10.38175/phnx.1320445

Öz

Objective: We evaluated the distribution, use of antivenom, treatments applied during the follow-ups, and effects on the use of NLR and MPV antivenom in cases of snake bites and scorpion stings followed in the paediatric intensive care unit (PICU) and the effects of these cases on the length of stay in the intensive care unit and hospital.
Materials and Methods: Demographic characteristics of the patients followed in the PICU and the severity of their clinical findings at admission, antivenom use after snake and scorpion bites were retrospectively examined from the clinical course in the hospital automation system and archived file records.
Results: Of 38 patients who were followed up in the PICU for snake and scorpion bites, half were followed up for snake bites and half for scorpion bites. Antivenom treatment was applied according to the clinical stage. There was a positive correlation between antivenom-administered patients and NLR (p<0,05). When snake bites and scorpion stings were examined separately, there was a positive correlation between antivenom application and NLR in snake bites (p<0.05), but no correlation was found in scorpion stings (p>0.05).
Conclusion: Consequently, antivenom therapy is the main treatment for snake bites and scorpion stings. We think that the NLR value will be significant in deciding to apply antivenom to patients, especially in snake bites. In addition, those with high NLR values need to be closely observed in terms of compartment development.

Anahtar Kelimeler

Paediatric intensive care, snake and scorpion bite, neutrophil/lymphocyte ratio, antivenom administration

Yılan ve Akrep Sokmalarında Nötrofil/Lenfosit Oranı ve Ortalama Trombosit Hacminin Antivenom Kullanımına Etkisi

Öz

Amaç: Çocuk yoğun bakım ünitesinde (ÇYBÜ) yılan ve akrep sokmasıyla takip edilen hastalarda NLR VE MPV değerlerinin antivenom kullanımına etkisini ve bu değerlerin yoğun bakım ünitesi ve hastanede kalış sürelerine etkisini değerlendirmek amaçlandı.
Gereç ve Yöntem: Yoğun bakım ünitesinde izlenen hastaların demografik özellikleri ve başvuru anındaki klinik bulgularının şiddeti, yılan ve akrep sokması sonrası antivenom kullanımı, hastane otomasyon sistemindeki klinik seyir ve arşivlenen dosya kayıtlarından retrospektif olarak incelendi.
Bulgular: ÇYBÜ’de yılan ve akrep sokması nedeniyle izlenen 38 hastanın yarısı yılan, yarısı akrep sokması nedeniyle takibe alındı. Klinik evreye göre antivenom tedavisi uygulandı. Antivenom uygulanan hastalar ile NLR arasında pozitif korelasyon saptandı (p<0,05). Yılan sokması ve akrep sokması ayrı ayrı incelendiğinde antivenom uygulaması ile NLR arasında yılan sokmasında pozitif korelasyon bulunurken (p<0,05), akrep sokmasında ise herhangi bir korelasyon bulunmadı (p>0,05).
Sonuç: Sonuç olarak yılan sokması ve akrep sokmalarında ana tedavi antivenom tedavisidir. Özellikle yılan sokmalarında hastalara panzehir uygulama kararı vermede NLR değerinin önemli olacağını düşünüyoruz. Ayrıca NLR değeri yüksek olanların kompartıman gelişimi açısından yakından izlenmesi gerekir.

Anahtar Kelimeler

Çocuk yoğun bakım, Yılan ve akrep ısırığı, Nötrofil lenfosit oranı, Antivenom uygulaması

Kaynakça

• Kara ME, Ay MO, Seğmen S, Avcı A, İçme F, Gökel Y. Management of snake bites. Archives Medical Review Journal. 2014;23:272–92.
• Calvete JJ. Proteomic tools against the neglected pathology of snake bite envenoming. Expert Rev. Proteomics 2011;8, 739–758.
• Bush SP, Mooy GG, Phan TH. Catastrophic acute ischemic stroke after crotalidae polyvalent immune Fab (ovine)-treated rattlesnake envenomation. Wilderness Environ Med. 2014;25 (2):198-203.
• Yılmaz HL. Akrep Sokması. İçinde: Karaböcüoğlu M, Yılmaz HL, Duman M (eds). Çocuk Acil Tıp: Kapsamlı ve Kolay Yaklaşım. 1. Baskı. İstanbul: İstanbul Tıp Kitapevi, 2012:1777-85.
• Bosnak M, Levent Yilmaz H, Ece A, Yildizdas D, Yolbas I, et al. Severe scorpion envenomation in children: management in pediatric intensive care unit. Hum ExpToxicol. 2009;28:721-8.
• Wang JD, Tsan YT, Yan‐Chiao M, Wang LM. Venomous snakebites and antivenom treatment according to a protocol for pediatric patients in taiwan. J Venom Anim Toxins incl Trop Dis. 2009;15:667‐79.
• Bhat T, Teli S, Rijal J, Raza M, Khoueiry G, Meghani M, et al. Neutrophil to lymphocyte ratio and cardiovascular diseases: A review. Expert Rev Cardiovasc Ther. 2013;11:55-9.
• Kilincalp S, Çoban Ş, Akinci H, Hamamcı M, Karaahmet F, Coşkun Y. et al. Neutrophil/lymphocyte ratio, platelet/lymphocyte ratio, and mean platelet volüme as potential biomarkers for early detection and monitoring of colorectal adenocarcinoma. Eur J Cancer Prev. 2015;24:328-33.
• Forget P, Khalifa C, Defour JP, Latinne D, Van Pel MC, De Kock M. What is the normal value of the neutrophil-to-lymphocyte ratio? BMC research notes. 2017;10(1),12. https://doi.org/10.1186/s13104-016-2335-5.
• Ahsen A, Ulu MS, Yuksel S, Demir K, Uysal M, Erdogan M, Acarturk G. As a new inflammatory marker for familial Mediterranean fever: neutrophil-to-lymphocyte ratio. Inflammation. 2013;36(6):1357-1362. https://doi.org/10.1007/s10753-013-9675-2.
• Yilmaz E, Bayram KA, Bozpolat A, Zararsiz G, Gorkem BS, Karakukcu M, et al. The relationship between hematological parameters and prognosis of children with acute ischemic stroke. Childs Nerv Syst. 2018;34:655-61.
• Basaran O, Uncu N, Celikel BA, Aydın F, Cakar N. Assessment of neutrophil to lymphocyte ratio and mean platelet volume in pediatric familial Mediterranean fever patients. J Res Med Sci. 2017;15:22-35.
• Sönmez BM, Yılmaz F, Yılmaz MS, Kavalcı C, Gökhan Ş, Akbulut AS, et al. Clinical aspects and emergent management of snake bites presented to emergency department. J Clin Anal Med. 2015;6:558–61.
• Yilmaz E, Bayram KA, Bozpolat A, Zararsiz G, Gorkem BS, Karakukcu M, et al. The relationship between hematological parameters and prognosis of children with acute ischemic stroke. Childs Nerv Syst. 2018;34:655-61.
• Satar S, Karcioglu O, Sebe,A. An unusual localization of snakebite treated without antivenin: case report. The Mount Sinai Journal of Medicine. 2005;72(2).116-119.
• Zengin N, Anil M, Anil A, Kamit F, Bal A, Bıcılıoğlu Y, et al. Clinical Characteristics of Pediatric Scorpion Envenomation in the Aegean Region: An Experience of a Training and Research Hospital. Turkish Journal of Pediatric Emergency and Intensive Care Medicine. 2016;69-75. 10.4274/cayd.52714.
• Elbey B, Baykal B, Yazgan ÜC, Zengin Y. The prognostic value of the neutrophil/lymphocyte ratio in patients with snake bites for clinical outcomes and complications. Saudi Journal of Biological Sciences. 2017;24(2).362-366. https://doi.org/10.1016/j.sjbs.2015.10.002
• Aktar F, Tekin R. Mean platelet volume, neutrophil to lymphocyte ratio in determining the diagnosis or outcome in children with snakebite. Arch Argent Pediatr. 2017;115:576-80.