Systemic interleukin-6 response in patients bitten by viperidae snakes

ABSTRACT

Envenomation by viperidae snakes causes local tissue damage similar to acute trauma in addition to various systemic effects of which coagulopathy is a major and lethal complication. Interleukin-6 [IL-6] is an important proinflammatory cytokine produced usually due to trauma. The present study was designed to investigate the possible role of IL-6 in the development of coagulopathy and its association with the severity of envenomation in patients. Thirty one adults patients of both sexes were included in this study divided according to the scoring system used to classify the severity of envenomation caused by vipers to four groups [group II mild grade, group III moderate grade, group IV severe grade and group V critical grade] in addition to six healthy adults of both sexes served as control group [group I]. Blood samples were taken on admission to hospital, then 24 and 48 hours after snake bite. Coagulation profile [Prothrombin Time [PT], Activated Partial Thromboplastin Time [APTT], Fibrinogen level and Fibrin Degradation Products [FDPs] was determined. Also hematological tests were done [red blood cell count [RBCs], hemoglobin concentration [Hb%], white blood cell count [WBC] and platelet count]. Moreover IL-6 level was determined. The results revealed that envenomated patients presented with coagulopathy, showed significant increase of PT and APTT time, FDPs level and significant decrease of fibrinogen level, in addition to the abnormalities of hematological tests which manifested by significant decrease of RBCs, I-IB% and platelet count. These changes were significant in group V followed by IV and III while insignificant in group II. Such alterations were more on admission, decreased but still significant after 24 hours then returned to near normal values after 48 hours. As regard serum IL-6 level it showed significant increase in groups V followed by IV and III while there was insignificant increase in group II. Such increase was more on admission, decreased but still significant after 24 hours then returned to normal values after 48 hours. In conclusion, this study showed that IL-6 could be involved in the pathogenesis of systemic coagulopathy in envenomated patients also there was a significant association between severity of envenomation and IL-6 concentration, being higher in the critical and severe grades than the moderate and mild grades