Inflammatory and Metabolic Ratios as Supportive Markers for Differentiating Snakebite from Scorpion Sting in the Emergency Department: A 10-Year Retrospective Study

Aim: In emergency settings, distinguishing between snakebite and scorpion sting may be challenging due to similar presenting features, even though the underlying biological effects differ substantially. In situations where clinical history is limited or unclear, simple laboratory-based indicators may provide additional guidance. This study investigated whether inflammation- and metabolism-related indices, specifically the neutrophil-to-lymphocyte ratio (NLR) and glucose-to-potassium ratio (GPR), could assist in differentiating these two types of envenomation. Material and Methods: A retrospective evaluation was carried out including patients diagnosed with either snakebite or scorpion sting over a ten-year period at a tertiary care emergency department. Patient demographics, clinical characteristics, and laboratory findings were obtained from archived medical records. NLR and GPR values were derived from laboratory measurements recorded at admission. Their discriminatory performance was analyzed using receiver operating characteristic (ROC) curves. Exploratory univariate logistic regression was performed to examine whether higher NLR and GPR values were associated with snakebite. The combined model output was interpreted as predicted probability. Results: Eighty-nine patients were included in the analysis, consisting of 37 snakebite and 52 scorpion sting cases. Patients with snakebite demonstrated significantly higher NLR and GPR values (p < 0.05). Both indices showed meaningful diagnostic performance in ROC analysis, and their combined use resulted in improved discrimination between the two conditions. In exploratory univariate logistic regression, elevated NLR and GPR were associated with snakebite. Conclusion: NLR and GPR may serve as supportive and readily available adjunctive biomarkers for differentiating snakebite from scorpion sting; however, they should be interpreted together with clinical findings rather than as standalone diagnostic tools.