Faculty of Medicine, Department of Pediatric Nephrology, Cukurova University, Adana, Turkey.
Faculty of Medicine, Department of Radiology, Cukurova University, Adana, Turkey.
Eur J Pediatr. 2023 Dec;182(12):5591-5598. doi: 10.1007/s00431-023-05250-3. Epub 2023 Oct 7.
Crush syndrome due to traumatic rhabdomyolysis is one of the most significant problems to occur following earthquakes. On February 6, 2023, millions of people in Turkey were affected by two consecutive Kahramanmaraş earthquakes. The present study reports the analysis of clinical and laboratory findings of crush syndrome in pediatric earthquake victims admitted to our hospital from our region where the earthquake had a devastating effect. Clinical and laboratory findings concerning earthquake victims with crush syndrome were analyzed within the first week to determine what factors are predictive of kidney replacement therapy (KRT). The data of patients were retrospectively collected from medical records. A total of 310 children were admitted as earthquake victims to the pediatric emergency department. Ninety-seven (31%) of these patients had crush syndrome. Fifty-three (55%) of those with crush syndrome were female. The mean age was 10.9 ± 4.7 years, and the mean time under the rubble was 30.6 ± 23.8 h. Twenty-two patients (23%) required KRT. Hemodialysis was applied to 16 (73%) of them, and hemodiafiltration was applied to the other six (27%) in the pediatric intensive care unit. Regarding creatine kinase (CK) levels, the area under the receiver operating characteristic (ROC) curve (AUC) for predicting KRT was 0.905 (95% confidence interval [CI] 0.848-0.963; p < 0.001). The optimal cut-off value was 40,000 U/L with a sensitivity of 86% and a specificity of 83%. In terms of the percentage of body area crushed, the AUC for predicting KRT was 0.907 (95% CI 0.838-0.976; p < 0.001). The optimal cut-off value was 30% with a sensitivity of 86% and a specificity of 88%. Multiple logistic regression analysis showed that each 10% increase in body area crushed (OR 4.16, 95% CI 1.58-10.93, p = 0.004) and 1 mg/dl increase in the serum phosphorus level (OR 4.19, 95% CI 1.71-10.28, p = 0.002) were significant risk factors for dialysis treatment.
Crush syndrome and kidney problems are common following disasters like earthquakes. Clinical and laboratory findings at admission can predict dialysis requirement in earthquake victims. While CK elevation, body area crushed percentage, and increased phosphorus level were predictive of dialysis treatment, time under the rubble was not. Even if the patients were under the rubble for a short time, acute kidney injury (AKI) may develop as a result of severe hypovolemia due to crush injuries, and patients may need KRT.
•Crush syndrome after earthquakes needs to be treated carefully in victims and can cause AKI and mortality when not treated timely and appropriately.
•CK level elevation, body area crushed percentage, and increased phosphorus level are predictive of dialysis treatment. •The time under the rubble may not be predictive of dialysis requirement.
创伤性横纹肌溶解导致的挤压综合征是地震后最严重的问题之一。2023 年 2 月 6 日，土耳其连续发生两次卡赫拉曼马拉什地震，数百万人受到影响。本研究报告了从受地震影响严重的本地区送入我院的儿科地震伤员中挤压综合征的临床和实验室检查结果分析。在第一周内分析了挤压综合征患儿的临床和实验室检查结果，以确定哪些因素与肾脏替代治疗（KRT）有关。从病历中回顾性收集了患者的数据。共有 310 名儿童因地震被送入儿科急诊室。其中 97 名（31%）患儿患有挤压综合征。患有挤压综合征的 97 名患儿中 53 名（55%）为女性。平均年龄为 10.9±4.7 岁，被埋在废墟下的平均时间为 30.6±23.8 小时。22 名（23%）患者需要 KRT。其中 16 名（73%）接受了血液透析，6 名（27%）在儿科重症监护病房接受了血液透析滤过。关于肌酸激酶（CK）水平，预测 KRT 的受试者工作特征（ROC）曲线下面积（AUC）为 0.905（95%置信区间 [CI] 0.848-0.963；p<0.001）。最佳截断值为 40000U/L，敏感性为 86%，特异性为 83%。就身体受压面积百分比而言，预测 KRT 的 AUC 为 0.907（95% CI 0.838-0.976；p<0.001）。最佳截断值为 30%，敏感性为 86%，特异性为 88%。多因素逻辑回归分析显示，身体受压面积每增加 10%（OR 4.16，95%CI 1.58-10.93，p=0.004）和血清磷水平每增加 1mg/dl（OR 4.19，95%CI 1.71-10.28，p=0.002）是透析治疗的显著危险因素。
挤压综合征和肾脏问题在地震等灾害后很常见。入院时的临床和实验室检查结果可预测地震伤员的透析需求。虽然 CK 升高、受压面积百分比和磷水平升高可预测透析治疗，但废墟下的时间则不能。即使患者在废墟下的时间很短，由于挤压伤导致的严重血容量不足，也可能导致急性肾损伤（AKI），患者可能需要 KRT。
•地震后的挤压综合征需要对患者进行仔细治疗，如果不及时、适当治疗，可能会导致 AKI 和死亡率。
•CK 水平升高、受压面积百分比和磷水平升高可预测透析治疗。•废墟下的时间可能不能预测透析的需求。
