EVALUATION OF THE EARLY PROGNOSTIC VALUE OF NEUTROPHIL-LYMPHOCYTE RATIO (NLR) AND PLATELET-LYMPHOCYTE RATIO (PLR) IN SNAKEBITE POISONED PATIENTS

Neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) have recently gained popularity as simple, inexpensive, and highly accurate inflammatory markers and they have been suggested as useful predictors for clinical prognosis in critically ill patients in various medical conditions. This study aimed to assess the usefulness of NLR and PLR in predicting the severity of clinical profile and outcome in patients with snake poisoning. Methods: a prospective study from January to August 2016 and a retrospective one from January to December 2015 were conducted on all snake envenomated patients admitted to Poison Control Center of Ain Shams University Hospitals. On admission, complete medical history, physical examination and biochemical laboratory investigations including complete blood count (CBC) and international normalized ratio (INR), were recorded. NLR and PLR were calculated from the differential total leukocyte count (TLC). Outcome data as; intensive care unit (ICU) and hospital stay time, number of anti-venom (NAV) ampoules needed, occurrence of complications and death, were also documented. The patients were classified in to three main groups, according to the degree of severity; Group II (mild grade); Group III (moderate grade) and Group IV (severe grade). In addition to, Group I (control group). Results: 50 patients, 46 males (92%), with mean age (31.54±11.97 years) met inclusion criteria. The frequency of bites in the lower limb was significantly higher than those in the upper limb in all patient groups. There was significant leukocytosis, neutophilia and higher LNR in group III and group IV as compared to group I and group II. Significant lymphocytopenia and thrombocytopenia was evident in group III and group IV as compared to group I and also in group IV compared to group II. INR was statistically higher in group IV in comparison with the other groups. There was significant correlation of NLR level with INR, platelet count, PLR, NAV, ICU stay time and hospital stay time. While, PLR showed non-significant difference between the studied groups as well as non-significant correlation with the outcome parameters. The mortality rate of the study was (2%). Conclusion: High levels of on admission NLR were associated with worse clinical profile and poorer outcome. This was not evident with PLR. NLR was found to function as a new easily calculated readily available biomarker that successfully predicts the prognosis of clinical severity and outcome in snake poisoned patients.