| Objective: This study describes the epidemiological characteristics of wasp sting,the clinical characteristics of severe wasp sting patients,the damage of wasp sting to various organs and the prognosis of wasp sting patients in a top three hospital in northern Guizhou.The risk factors of severe wasp sting,liver injury,kidney injury and death were analyzed.The purpose is to provide basis for comprehensive prevention and control of local wasp stings.Methods: The total of 869 hospitalized cases with a clear diagnosis of wasp sting,which were diagnosed for the first time and had complete case data,were collected from a top-three hospital in northern Guizhou from January 1,2012 to December 31,2020.Clinical data of the patients were extracted,including demographic characteristics(name,age,gender),wasp stings(time,site,species,number of skin lesions),time of consultation at this hospital,early treatment history,past medical history,clinical manifestations,laboratory test results at 24 hours of admission(blood routine,electrolytes,liver function,kidney function,coagulation function,cardiac enzymes,urinary and fecal routine),treatment plan,complications and outcome.clinical presentation,24-hour laboratory results(blood count,electrolytes,liver function,kidney function,coagulation,cardiac enzymes,stool and urine routine),treatment plan,complications and outcome.The included case data were divided into severe and mild to moderate groups,liver injury and non-hepatic injury groups,kidney injury and non-kidney injury groups,and death and survival groups according to the disease severity grading,liver and kidney function impairment and outcome.Data entry of the patients’ clinical data was performed using an Excel sheet,and the data were statistically analysed using the statistical software SPSS19.0.Results: 1.A total of 869 patients with wasp sting were included in this study,of which151 were severe,304 were moderate and 414 were mild.The wasp sting occurred mostly in summer and autumn.The mean age of the patients was 39.267±22.777 years,of which59.03% were males and 40.97% were females.The site of the sting was most commonly the head,face and neck(87.69%),with number of skin lesions ≥30 predominating(87.34%).The average time of consultation at this hospital was 27.242 ± 61.116 hours.The average length of stay was 8.113 ± 9.742 days.And there were 25 deaths(mortality rate 2.88%),all of which were severe wasp sting.2.Severe wasp sting occurred mostly in autumn.The mean age of the patients was 51.086±16.757 years;of which 60.93% were male and 39.07% were female.Stings were most common on the head,face and neck(98.68%),followed by both upper limbs(80.79%),the trunk(53.64%)and both lower limbs respectively(41.72%).And number of skin lesions ≥30 accounted for98.01%.The average time of consultation at this hospital was 38.205±61.681 hours.The average length of stay was 16.13±17.34 days.3.The common clinical manifestations of severe wasp sting included palpitations(38.41%),haematuria(37.75%),shortness of breath(32.45%),shock(25.50%),oliguria and anuria(17.88%),coma(9.27%),drowsiness(5.96%),incontinence(1.99%),convulsions(1.99%)and near-death feeling(0.66%).The incidence of each clinical manifestation was statistically different compared to the mild to moderate group.4.The composition ratios of leukocytes,hemoglobin,platelets,potassium ions,ALT,AST,total bilirubin,creatinine,creatine kinase,CKMB,PT,APTT,urine routine and stool routine in patients with severe wasp sting were statistically significantly different compared with the mild to moderate group.Multifactorial regression analysis revealed age,hemoglobin <90 g/L,high potassium,total bilirubin >17.1 umol/L,creatinine >177 umol/L,and positive for urine routine red blood cells as risk factors for progression from wasp sting to severe wasp sting.5.Patients with severe wasp sting mainly presented with MODS(88.08%).And there was a statistically significant difference in the distribution of acute liver injury(65.56%),acute kidney injury(56.29%),coagulation dysfunction(52.98%),rhabdomyolysis(51.66%),acute respiratory distress syndrome(45.03%),haemolytic anaemia(43.71%),anaphylaxis(24.50%)and acute gastric mucosa damage(17.22%)from the mild to moderate group.Multi-factor regression analysis showed that number of skin lesions ≥30,high potassium,elevated PT,elevated APTT,and positive for urine routine red blood cells were risk factors for progression of wasp sting to liver injury.Multi-factor regression analysis showed that number of skin lesions ≥30,high potassium,and positive for urine routine red blood cells are risk factors for progression of wasp sting to renal injury.6.Of all wasp sting patient cases,844 improved(survival rate of 97.12%)and 25 died(mortality rate of 2.88%).All patients who died were severe wasp sting patients and the causes of death were MODS(72.00%),acute respiratory distress syndrome(16.00%),anaphylaxis(8.00%)and cerebral haemorrhage(4.00%).The death group of severe wasp sting patients was compared to the survival group.There was a statistically significant difference in the time to presentation of patients.Conclusion: Wasp sting occurs most often in summer and autumn.Age,hemoglobin,potassium,total bilirubin,creatinine and urine routine predict the severity of wasp sting.Number of skin lesions ≥30,high potassium,elevated PT,elevated APTT and positive for urine routine red blood cells are the risk factors for wasp sting to progress to liver injury.Number of skin lesions ≥30,high potassium and positive for urine routine red blood cells are risk factors for wasp sting to progress to kidney injury.And death in patients with severe wasp stings was related to time of consultation at this hospital. |
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