Comoglu Mustafa, Acehan Fatih, Inan Osman, Demir Burak Furkan, Yılmaz Yusufcan, Sahiner Enes Seyda
Department of Internal Medicine, Ankara Bilkent City Hospital, Ankara, Turkey.
Department of Internal Medicine, Ankara Bilkent City Hospital, Ankara, Turkey.
Am J Emerg Med. 2025 Jan;87:1-7. doi: 10.1016/j.ajem.2024.10.031. Epub 2024 Oct 18.
It is important to predict which patients may require renal replacement therapy (RRT) at the time of initial presentation after crush injuries. There is limited data in the literature examining the predictors of RRT.
This study was conducted by evaluating 2232 patients who presented to our hospital following two major earthquakes of magnitudes 7.6 and 7.7 Mw that occurred in Kahramanmaras, Turkey, on February 6, 2023. A total of 314 patients who were hospitalized upon being rescued from the rubble and had a creatine kinase (CK) level above 1000 U/L were included in the final analysis. Factors predicting the need for RRT were investigated, and a dialysis score was developed for this prediction.
Of the 314 patients included in the study, 95 (30.2 %) developed acute kidney injury (AKI). RRT was performed on 68 (21.6 %) patients. The optimal cut-off value of CK for the prediction of AKI was 23,000 U/L. Multivariate analysis revealed that factors predicting RRT were the number of traumatized sides (odds ratio [OR]: 2.2, 95 % confidence interval [CI]: 1.09-4.39, p = 0.026), albumin (OR:0.11, 95 % CI: 0.04-0.32, p < 0.001), and CK (OR: 1.00, 95 % CI 1.00-1.00, p < 0.001). A dialysis score was developed ranging from 0 to 7 based on the number of traumatized sides, albumin, and CK. The area under the curve (AUC) of the dialysis score in receiver operating characteristic analysis was 0.974. A dialysis score of 4 or higher had a sensitivity of 97.1 % and a specificity of 89.4 % for predicting the need for RRT.
The dialysis score predicts the need for RRT quite well. The simplicity of use and high sensitivity and specificity of this score in earthquake-related crush injuries will greatly facilitate clinicians in patient triage and follow-up.
在挤压伤初次就诊时预测哪些患者可能需要肾脏替代治疗（RRT）很重要。文献中关于RRT预测因素的数据有限。
本研究通过评估2023年2月6日发生在土耳其卡赫拉曼马拉什的两次7.6级和7.7级Mw大地震后到我院就诊的2232例患者进行。最终分析纳入了从废墟中获救后住院且肌酸激酶（CK）水平高于1000 U/L的314例患者。研究了预测RRT需求的因素，并为此预测制定了透析评分。
在纳入研究的314例患者中，95例（30.2%）发生急性肾损伤（AKI）。68例（21.6%）患者接受了RRT。预测AKI的CK最佳截断值为23000 U/L。多因素分析显示，预测RRT的因素为受伤侧数（比值比[OR]：2.2，95%置信区间[CI]：1.09 - 4.39，p = 0.026）、白蛋白（OR：0.11，95% CI：0.04 - 0.32，p < 0.001）和CK（OR：1.00，95% CI 1.00 - 1.00，p < 0.001）。根据受伤侧数、白蛋白和CK制定了范围从0到7的透析评分。在受试者工作特征分析中，透析评分的曲线下面积（AUC）为0.974。透析评分4分及以上预测RRT需求的灵敏度为97.1%，特异度为89.4%。
透析评分对RRT需求的预测效果良好。该评分在与地震相关的挤压伤中使用简单，灵敏度和特异度高，将极大地便利临床医生对患者进行分诊和随访。
