Prognostic Value of Red Blood Cell Width Distribution-to-Platelet Ratio in Patients with Snakebite-Associated Multiple Organ Dysfunction Syndrome: A Retrospective Observational Study.

Background: Snakebite-induced organ dysfunction emerging as the primary determinant of morbidity and mortality. This study aims to explore the prognostic value of red blood cell distribution width (RDW) to platelet ratio (RPR) on multi-organ dysfunction (MODS) in patients with snake bites.

Methods: A retrospective study included 637 patients with snakebite between 2015 and 2020 from two hospitals in Anhui province, China. Data were collected at two time points: on the 1^st-day and the 5^th-day after treatment. All patients were divided into two groups according to the presence or absence of MODS. T-tests, chi-square tests, and univariate and multivariate logistical analyses were used to identify the prognostic factors for the development of MODS.

Results: 56 (8.8%) patients developed MODS following snakebite. Logistics analyses indicated that from being bitten at the hospital, the 1^st-day of red blood cell distribution width-to-platelet ratio (RPR) and creatinine (CR) levels, and the 5^th-day of aspartate aminotransferase (AST) were significantly associated with the development of MODS. The sensitivity and the specificity of the 1^st-day RPR were calculated by the received operating characteristic curve (AUC=0.720, 95% CI, 0.642-0.798). The 1^st day RPR=0.110 and the 5^th day RPR=0.085.

Conclusion: The study found that the RPR is an independent risk factor for predicting multi-organ dysfunction in patients with snake bites. The 1^st-day RPR >0.110 is prone to be a new independent predictive factor for the development of MODS after snakebite.