Crush syndrome and mortality predictors in intensive care unit patients after earthquakes

Background: This study aimed to characterize the clinical features, morbidity, and in-hospital mortality of patients admitted to the intensive care unit (ICU) following the Turkey–Syria earthquakes, with particular attention to the prevalence of Crush Syndrome (CS) and the identification of prognostic factors influencing its development and patient outcomes. Methods: Clinical data from 108 patients who were admitted to the ICU for earthquake-related trauma were retrospectively reviewed to assess their demographic characteristics, clinical presentation, duration of entrapment under rubble, treatment measures, blood gas parameters, laboratory results, ICU length of stay, occurrence of CS, and hospital mortality. Results: Among the 108 patients (mean age, 37 ± 18 years), the in-hospital mortality rate was 29%. Mortality was found to be significantly associated with higher Acute Physiology and Chronic Health Evaluation (APACHE) II scores, lower Glasgow Coma Scale scores, and increased levels of aspartate aminotransferase, alanine aminotransferase, creatine kinase (CK), peak CK, creatinine, troponin I, and red cell distribution width, as well as with decreased pH and bicarbonate levels (p < 0.05 for all). Troponin I exhibited the highest prognostic performance, with an area under the curve of 0.85, sensitivity of 83%, and specificity of 78% at a cut-off value of 257 ng/L. CS was diagnosed in 81 patients (75%), with a median CK level of 44,915 U/L (interquartile range, 15,000–122,250). Male sex and younger age were significantly associated with the development of CS (p < 0.05). Conclusions: Elevated troponin I levels at admission could be strongly associated with in-hospital mortality among earthquake victims requiring ICU care. CS was highly prevalent, particularly among younger and male patients, indicating the need for early recognition and targeted management strategies in this population.

Acute kidney injury; Crush syndrome; Earthquake; Troponin

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