Crush syndrome outcomes after earthquake

Background: Earthquakes are catastrophic natural disasters that result in complex and severe medical conditions such as the crush syndrome. This study aimed to investigate the association between trauma scores, laboratory findings, mortality, and the development of crush syndrome in patients affected by the Kahramanmaraş Pazarcık earthquake. Methods: A retrospective analysis was conducted on trauma cases from the Kahramanmaraş Pazarcık earthquake, which occurred on 06 February 2023, and were treated at the Dicle University Hospital emergency department. Receiver operating characteristic (ROC) curve analysis and logistic regression were used to assess predictors of mortality and crush syndrome. Results: Of the 118 patients included, 110 survived and 8 died. The injury severity score (ISS) was the most accurate predictor of mortality (area under the curve (AUC): 0.935; sensitivity: 87.5%; specificity: 90%; positive predictive value (PPV): 38.89%; negative predictive value (NPV): 99%). Potassium level was the most predictive laboratory parameter (AUC: 0.894; sensitivity: 87.5%; specificity: 83.64%; PPV: 28%; NPV: 98.92%). However, multivariate analysis did not identify these variables as independent risk factors for mortality. Crush syndrome developed in 70 patients (59.3%), ISS was identified as the best trauma score for predicting crush syndrome (AUC: 0.822; sensitivity: 87.14%; specificity: 64.58%; PPV: 78.21%; NPV: 77.50%), and among laboratory markers, aspartate aminotransferase (AST) demonstrated the highest predictive ability (AUC: 0.850; sensitivity: 88.57%; specificity: 68.75%; PPV: 80.52%; NPV: 80.49%). Multivariate analysis revealed that C-reactive protein (CRP) (odds ratio (OR): 1.018; 95% confidence interval (CI): 1.005–1.030; p = 0.006), lactate dehydrogenase (LDH) (OR: 0.997; 95% CI: 0.994–1.000; p = 0.030), and ISS (OR: 1.105; 95% CI: 1.019–1.197; p = 0.015) were independent predictors of crush syndrome. Conclusions: In conclusion, CRP, LDH, and ISS were identified as independent risk factors for crush syndrome among earthquake victims. In contrast, neither trauma scores nor laboratory parameters independently predicted mortality.

Earthquake; Crush syndrome; Mortality; Trauma scores; Injury severity score; C-reactive protein

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