Predictive value of admission blood glucose for early severity stratification in pediatric scorpion envenomation

Abstract

Background: Scorpion stings are an increasing public health concern in Brazil, where children are at a heightened risk of severe outcomes. Simple biomarkers, such as admission blood glucose may improve early risk stratification. Therefore, the present study aimed to assess the association between admission blood glucose and clinical severity in children envenomated by Tityus serrulatus. Methods: This prospective observational cohort study was conducted at João XXIII Hospital, Minas Gerais State Hospital Foundation (FHEMIG), Belo Horizonte, Brazil, from September 2023 to March 2024. We included patients aged 0 to 17 years with confirmed scorpion envenomation. Clinical severity was classified as mild (no antivenom) or moderate/severe (antivenom administered). Blood glucose was measured at admission and two hours thereafter. Predictive performance was assessed using receiver operating characteristic (ROC) analysis. Results: Sixty-seven children were included; 13.4% progressed to moderate/severe envenomation. Admission glucose ≥ 142 mg/dL showed 100% specificity and a 100% positive predictive value for severe cases (ROC AUC 0.979; 95% CI, 0.937–1.000; p < 0.001). A 105 mg/dL threshold maximized sensitivity (100%) at the expense of lower specificity (79.3%). To our knowledge, this is the first study to systematically evaluate admission glucose in pediatric T. serrulatus envenomation and to propose cutoffs for risk stratification. Conclusion: Admission blood glucose is an accessible and accurate biomarker for early triage of severity in pediatric scorpion envenomation. A 105 mg/dL threshold favors maximal sensitivity for screening, whereas 142 mg/dL ensures high specificity for severe cases. Although promising, these cutoffs should be treated as clinical hypotheses and require multicenter external validation before widespread adoption.