Risk factors for venom-induced consumption coagulopathy after snakebite in Yunnan, China: a multicenter retrospective study

Background Venom-induced consumption coagulopathy (VICC) is an important systemic manifestation of hemotoxic snake envenomation. The factors associated with VICC remain poorly explored in Yunna. This study aimed to identify factors associated with VICC among patients bitten by snakes with predominantly hemotoxic venom. Methods We conducted a multicenter retrospective study using the Yunnan Snakebite Injury Database. Patients with documented snakebite who presented within 24 h and were bitten by snakes with predominantly hemotoxic venom were included. VICC at admission was defined as an international normalized ratio >1.2 together with either fibrinogen below the local lower reference limit or D-dimer ≥10 times the local upper reference limit, based on pretreatment laboratory results. Factors associated with VICC were evaluated using multilevel logistic regression with hospital-specific random intercepts. Results A total of 801 patients from 21 hospitals were included, of whom 114 (14.2%) had VICC at admission. Ovophis bites were associated with substantially higher odds of VICC than Trimeresurus bites (aOR7.65; 95%CI, 3.63–16.12). Longer prehospital delay was also associated with higher odds of VICC, with a 5% increase in odds for each additional hour from bite to hospital presentation (aOR, 1.05; 95% CI, 1.01–1.08). Associations were also observed for several reported prehospital first-aid practices; however, these findings should be interpreted cautiously because of the heterogeneous reference category and potential residual confounding. Conclusion Ovophis bites and longer prehospital delay were the principal factors associated with higher odds of admission VICC. Timely referral, availability of appropriate antivenoms in high-incidence areas, and improved snake identification at frontline facilities may facilitate earlier management of hemotoxic envenomation.