Analysis Of Clinical Features And Risk Factors Of 703 Patients Rhabdomyolysis Caused By Bee Sting

Objective:This study retrospectively analyzed the clinical data of patients with bee sting.In this study,we compared and analyzed the clinical characteristics of patients with rhabdomyolysis(RM)and those without RM,and explored the effects of bee sting Risk factors for rhabdomyolysis,at the same time,established risk factor prediction models.Methods:We collected clinical data of 1177 bee sting patients who were hospitalized in the affiliated hospital of Zunyi Medical University or the third affiliated hospital from January 2012 to October 2019.According to the inclusion exclusion criteria,a total of 703 patients were screened for study.The 218 patients with RM were regarded as the experimental group(RM group),and the 485 patients without RM were regarded as the control group(NRM group).The study analyzed the differences between the two groups of patients in terms of demographic data,history of previous basic diseases,clinical symptoms,laboratory examination results within 24 hours of admission,complications,treatment,and prognosis.Logistic regression model was used for single factor and multi-factor analysis to screen out the independent risk factors for the occurrence of RM in bee sting patients,and to establish a risk factor prediction model.The receiver operating characteristic curve(ROC)was used to evaluate the model Predicted value Results:1.In this study,the incidence of bee sting was higher from August to October(77.95%).The average age of patients was 49.94±13.93 years.The maj ority of bee sting are mainly young and middle-aged.The incidence of bee sting in males(55.33%)is higher than that in females(44.67%).The most common complications of bee sting were acute liver injury(40.83%)and toxic myocarditis(46.23%).RM was relatively common(31.01%).18 patients died during hospitalization,and the case fatality rate was 2.56%2.The average age of bee sting patients with RM was 52.49±13.84 years,which was higher than that of patients without RM.There was a significant difference in age between the two groups(P=0.001).Patients with RM are common in young and middle-aged people,accounting for 57.34%.The incidence of men(53.67%)is higher than that of women.The average age of female patients with bee sting RM(55.70±12.37 years old)was higher than that of male patients(50.11±14.21 years old),and the age difference between the two groups was statistically significant(P=0.008).However,there was no difference in stinging bees(P=0.432).There was no significant difference between female patients and male patients in muscle pain,hematuria,dizziness,headache symptoms,number of wounds,length of hospital stay,and mortality(P>0.05).However,female patients are more likely to develop coagulopathy than male patients(P=0.002).3.The clinical manifestations of bee sting combined with RM are diverse.Serological examination of the RM group showed a marked increase in inflammatory markers and serum enzymology,and impaired renal function.When combined with coagulopathy,the main manifestation was the prolongation of APTT.Patients with RM due to bee sting are more likely to have acute kidney injury(AKI),multiple organ dysfunction syndrome(MODS),acute liver injury,toxic myocarditis,coagulopathy.In addition,the patients in the RM group had longer hospital stays than those without RM,and had a higher rate of renal replacement therapy and hormone therapy,with a higher mortality rate(P<0.001).4.Gender,diabetes,hypertension,drinking,and smoking were not risk factors for patients with bee stings who occurs RM.Age?45 years old(OR 2.279,95%CI 1.231-4.220;P=0.009),time elapse from bite to hospital?8h(OR 5.34,95%CI 3.006-9.501;P=0.000),number of wounds?10 stings(OR 4.761,95%CI 2.170-10.447;P=0.000),white blood cells(WBC)?5×109/L(OR 4.957,95%CI 2.782-8.834;P=0.000),neutrophil ratio(NEU%)?0.915(OR 2.497,95%CI 1.399-4.455;P=0.002),wasp sting(OR 3.436,95%CI 1.347-8.764;P=0.010),Stings in multiple parts of the body(OR 6.700,95%CI 3.221-13.937;P=0.000)are independent risk factors for patients with bee stings who occurs RM.Albumin(OR 0.915,95%CI 0.857-0.977;P=0.007)is a protective factor for RM occurrence.5.Establish a regression equation for predicting RM in patients with bee stings:Logit(P)= 0.824×age+1.676×time elapse from bite to hospital+1.561×Number of wounds+1.601×white blood cells+0.915× neutrophil ratio-0.089 ×Albumin+1.234×Bees+1.902× Sting site-1.128,Area Under Curve(AUC)is 0.911>0.5(95%CI 0.883-0.939,P=0.000),the maximum value of the Youden index is 0.7,and the corresponding cut-off value is 0.532,which corresponds to Sensitivity is 80.9%,and the specificity is 89.1%,positive likelihood ratio(+LR)=7.422,negative likelihood ratio(-LR)=0.214.It shows that the multi-factor prediction model has a higher value for predicting whether RM occurs in patients with bee sting.Conclusion:1.The incidence of bee stings in Zunyi is relatively high from August to October,mainly among young and middle-aged people.The most common complications after bee sting are acute liver injury and toxic myocarditis.The clinical manifestations of RM patients caused by bee stings are diverse and lack specificity.They are more likely to incorporate multiple organ dysfunction and have a higher mortality rate.The number of wounds is related to the severity of the disease.2.Age?45 years old,the time from bee sting to hospitalization?8h,number of wounds?10 stings,white blood cells?15×109/L,neutrophil ratio?0.915,wasp sting,Stings in multiple parts of the body are independent risk factors for patients with bee stings who occurs RM.Albumin is a protective factor for RM occurrence.The establishment of the model based on the above factors has high predictive value.