Risk Prediction of Severe Complications Caused by Hymenoptera Insect Stings: Development and Validation of a Nomogram Mode

Jiahao Guan,1,* Zhenkai Zhao,2,* Zitong Wang,1,3 Mengyao Huang,4 Jun Wang,5 Zhenguo Liu,6 Yajuan Ren,7 Zifan Lu,8 Shuling Hu,1 Xianglong Duan9 1Department of Clinical Laboratory, Shaanxi Provincial People′s Hospital, Xi’an, Shaanxi, People’s Republic of China; 2Department of Burns and Plastic Surgery, Fourth Medical Center of Chinese PLA General Hospital, Beijing, People’s Republic of China; 3Medical College, Yan’ an University, Yan’an, Shaanxi, People’s Republic of China; 4Department of Information, Shaanxi Provincial People’s Hospital, Xi’an, Shaanxi, People’s Republic of China; 5Department of Respiratory MedicineI, Shaanxi Provincial People’s Hospital, Xi’an, Shaanxi, People’s Republic of China; 6Department of Critical Care Medicine, Shaanxi Provincial People’s Hospital, Xi’an, Shaanxi, People’s Republic of China; 7Department of Respiratory Medicine II, Shaanxi Provincial People’s Hospital, Xi’an, Shaanxi, People’s Republic of China; 8Translational medicine Center of Shaanxi Provincial People’s Hospital, Xi’an, Shaanxi, People’s Republic of China; 9Second Department of General Surgery, Shaanxi Provincial People’s Hospital, Xi’an, Shaanxi, People’s Republic of China*These authors contributed equally to this workCorrespondence: Xianglong Duan, Second Department of General Surgery, Shaanxi Provincial People′s Hospital, No. 256, Youyi West Road, Xi’an, Shaanxi, 710068, People’s Republic of China, Tel +86 029-85251331, Email [email protected]: Hymenopteran stings (Apidae/Vespidae) represent critical emergencies frequently encountered during summer and autumn seasons. These incidents can trigger localized inflammatory responses and severe systemic complications—including anaphylactic shock, acute organ injury, and multi-organ dysfunction—potentially leading to death, especially in resource-limited areas. While honeybee and wasp venom components (melittin/hyaluronidase vs kinins/phospholipase) and effects differ, potentially causing distinct complications, this study develops a universal early risk prediction tool without differentiating bee species. Based on clinical and simple lab indicators, it aims to help frontline providers optimize high-risk patient identification and intervention, reducing mortality and healthcare burden.Patients and Methods: We retrospectively analyzed 1124 hymenoptera sting patients from Shaanxi Provincial People’s Hospital (2014– 2023). After screening, 607 eligible patients were randomly divided into training (n=455) and validation (n=152) cohorts (3:1 ratio). Univariate and multivariate logistic regression identified severe complication independent risk factors, enabling nomogram development. Its discriminative ability, calibration, and clinical utility were assessed using ROC curves, calibration plots, and DCA in both cohorts.Results: Severe complications occurred in 33 patients (5.44%): anaphylactic shock (9, 1.48%), acute kidney injury (4, 0.66%), acute myocardial injury (6, 0.99%), multiple organ dysfunction (13, 2.14%), and coagulation dysfunction (1, 0.16%). Independent predictors were: white blood cell count (OR=1.192, 95% CI: 1.099– 1.293), systemic inflammatory response index (OR=1.046, 95% CI: 1.002– 1.093), and blood urea nitrogen (OR=1.374, 95% CI: 1.114– 1.695). The nomogram achieved AUCs of 0.954 (95% CI: 0.926– 0.982) in training and 0.985 (95% CI: 0.965– 1.000) in validation cohorts. Calibration showed good agreement (Hosmer-Lemeshow P > 0.05). DCA demonstrated significant clinical net benefit.Conclusion: This study’s nomogram effectively predicts severe sting complication risk, serving as a practical tool for primary care providers to identify high-risk patients early and improve decisions.Keywords: hymenoptera stings, white blood cell count, systemic inflammatory response index, urea nitrogen, nomogram