Clinical Risk Factors Associated with Poor Outcomes in Snake Envenoming: A Narrative Review.

Area of Science:

• Medical Research
• Toxicology
• Public Health

Background:

• Snakebite-related fatalities disproportionately impact impoverished regions with limited healthcare access and antivenom availability.
• Early medical intervention is critical for mitigating mortality and morbidity from snakebite envenoming (SBE).

Purpose of the Study:

• To review objective parameters beyond clinical assessment that influence SBE outcomes.
• To identify factors associated with poor SBE outcomes from existing literature.

Main Methods:

• Systematic review of observational, region-specific studies identifying factors linked to poor SBE outcomes.
• Analysis of biochemical, haematological, and clinical presentation data associated with SBE severity.

Main Results:

• Consistent findings across studies highlight treatment delays, vulnerable populations (children, pregnant women), and biochemical/haematological abnormalities (AKI, low platelets, leucocytosis, abnormal coagulation, elevated CK) as indicators of poor outcomes.
• Recognition of rare presentations (adrenal insufficiency, severe hypertension, intracranial hemorrhage, glaucoma, bowel ischemia) also impacts outcomes.

Conclusions:

• Existing evidence on factors affecting SBE outcomes is limited and requires validation.
• High-quality, multi-center studies using Core Outcome Sets (COS) and Patient-Reported Outcome Measures (PROMS) are essential to strengthen the evidence base for SBE management.