Baseline characteristics of the patients.

Objective
Snakebites remain an overlooked public health issue with high morbidity and mortality. In this study, we assess the impact of diabetes on disease severity in patients with venomous snakebites.
Methods
A retrospective cohort analysis was conducted on snakebite cases treated at eight hospitals in Fujian Province between December 2019 and December 2023. Snakebite severity was evaluated using the Snakebite Severity Score. Univariate and multivariate logistic regression analyses were performed to identify the factors associated with snakebite severity.
Results
The study included 537 patients. The average age of patients is 55 years. 54.93% (n = 295) were aged ≥55 years, 57.17% (n = 307) were male, and 13.41% (n = 72) had diabetes. In the multivariate logistic regression, diabetes (odds ratio [OR] = 5.51; 95% confidence interval [CI]: 3.18–9.55), time from snakebite to hospital (OR = 1.04; 95% CI: 1.01–1.07), and bite site (OR = 0.63; 95% CI: 0.41–0.97) were identified as independent predictors of snakebite severity. Subgroup analysis revealed significant sex differences among patients with diabetes. The odds ratio for moderate-to-severe outcome was 3.81 (95% confidence interval [CI]: 1.81–7.99) in males and 12.57 (95% CI: 5.72–27.60) in females, with an interaction p-value of 0.030. Additionally, diabetes was significantly associated with prolonged hospital length of stay (p < 0.01), increased costs (p < 0.01), higher complication rates (p < 0.01), and a greater likelihood of requiring debridement surgery (p < 0.01) compared to individuals without diabetes.
Conclusion
Diabetes is an independent predictor of disease severity in patients with snakebites, underscoring the need for clinicians to consider the diabetes status when assessing and managing snakebite risk. These findings provide valuable insights for optimizing care strategies for individuals with diabetes who have experienced venomous snakebites.

研究目的
蛇咬伤仍是一个被忽视的公共卫生问题，具有较高的发病率与死亡率。本研究旨在评估糖尿病对毒蛇咬伤（venomous snakebites）患者疾病严重程度的影响。

研究方法
本研究对2019年12月至2023年12月期间福建省8家医院收治的蛇咬伤病例开展回顾性队列分析（retrospective cohort analysis）。采用蛇咬伤严重程度评分（Snakebite Severity Score）评估蛇咬伤严重程度，通过单因素及多因素logistic回归分析（univariate and multivariate logistic regression analysis）筛选与蛇咬伤严重程度相关的影响因素。

研究结果
本研究共纳入537例患者，患者平均年龄为55岁。其中54.93%（n=295）的患者年龄≥55岁，57.17%（n=307）为男性，13.41%（n=72）合并糖尿病。多因素logistic回归分析结果显示，糖尿病（比值比[odds ratio, OR]=5.51；95%置信区间[confidence interval, CI]=3.18~9.55）、蛇咬伤至就诊的时间（OR=1.04；95%CI=1.01~1.07）以及咬伤部位（OR=0.63；95%CI=0.41~0.97）均为蛇咬伤严重程度的独立预测因素。亚组分析显示，糖尿病患者中存在显著的性别差异：男性患者中度至重度不良结局的OR为3.81（95%CI=1.81~7.99），女性患者则为12.57（95%CI=5.72~27.60），交互作用P值为0.030。此外，与非糖尿病患者相比，糖尿病患者的住院时长显著延长（P<0.01）、住院费用显著升高（P<0.01）、并发症发生率显著更高（P<0.01），且需要接受清创手术（debridement surgery）的概率显著增加（P<0.01）。

研究结论
糖尿病是蛇咬伤患者疾病严重程度的独立预测因素，这提示临床医师在评估与管理蛇咬伤风险时，应将患者的糖尿病病史纳入考量范畴。本研究结果为优化毒蛇咬伤合并糖尿病患者的诊疗策略提供了宝贵的参考依据。