Predictors of in-hospital mortality in patients with multiple wasp stings in southwest China

Background Multiple wasp stings can cause severe systemic toxicity, multiple organ dysfunction, and death, but early identification of high-risk patients remains challenging. This study aimed to describe the epidemiological and clinical characteristics of hospitalized patients with multiple wasp stings and to identify independent predictors of in-hospital mortality for early risk stratification. Methods In this single-center retrospective study, we analyzed 1,501 patients admitted for multiple wasp stings at Suining Central Hospital between 2011 and 2019. For descriptive analyses, all 1,501 patients were included. For comparative analyses and nomogram development, a subset of 714 adult patients with complete clinical and outcome data was included. Univariate and multivariable logistic regression analyses were performed to identify independent predictors of in-hospital mortality. A nomogram was subsequently constructed, and its discrimination was assessed using the area under the receiver operating characteristic curve (AUC). Results In the overall cohort of 1,501 patients, the median age was 52.1 years, 60.2% were male, and the median time from envenomation to hospital admission was 3 days. Major complications included liver injury (16.3%), rhabdomyolysis (15.7%), acute kidney injury (10.3%), myocardial injury (10.2%), hemolysis (4.5%), and pneumonia/acute respiratory distress syndrome (3.1%). Overall, 27.5% of patients required rescue therapy and 7.0% underwent dialysis. Among the 714 adult patients in the analytical cohort, 68 (9.5%) died during hospitalization. Multivariable logistic regression identified serum potassium (OR 2.55, 95% CI 1.59–4.09; p < 0.001), indirect bilirubin (per 10-unit increase; OR 1.15, 95% CI 1.04–1.28; p = 0.005), and prothrombin time (OR 1.14, 95% CI 1.03–1.27; p = 0.015) as independent predictors of in-hospital mortality. The nomogram showed acceptable discrimination, with an AUC of 0.72 (95% CI, 0.65–0.79). Conclusion In patients with multiple wasp stings, in-hospital mortality is closely associated with venom-induced multi-organ dysfunction. A nomogram incorporating serum potassium, indirect bilirubin, and prothrombin time may provide a practical and accessible tool for early risk stratification and help clinicians identify high-risk patients for timely intervention.