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Factors predicting kidney replacement therapy in pediatric earthquake victims with crush syndrome in the first week following rescue

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Abstract

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.

Conclusions: 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.

What is Known:

•Crush syndrome after earthquakes needs to be treated carefully in victims and can cause AKI and mortality when not treated timely and appropriately.

What is New:

•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.

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Data availability

All data generated or analyzed during this study are included in this published article.

Abbreviations

AKI:

Acute kidney injury

ALT:

Alanine aminotransferase

AST:

Aspartate aminotransferase

AUC:

Area under the ROC curve

BUN:

Blood urea nitrogen

CI:

Confidence interval

CK:

Creatine kinase

CVVHDF:

Continuous veno-venous hemodiafiltration

eGFR:

Estimated glomerular filtration rate

IQR:

Interquartile range

KRT:

Kidney replacement therapy

OR:

Odds ratio

PD:

Peritoneal dialysis

ROC:

Receiver operating characteristic

SD:

Standard deviation

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Funding

The authors declare that no funds, grants, or other support were received during the preparation of this manuscript.

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Authors and Affiliations

  1. Faculty of Medicine, Department of Pediatric Nephrology, Cukurova University, Adana, Turkey

    Bahriye Atmis, Aysun K. Bayazit, Cagla Cagli Piskin & Emel Saribas

  2. Faculty of Medicine, Department of Radiology, Cukurova University, Adana, Turkey

    Ferhat Can Piskin

  3. Faculty of Medicine, Department of Pediatric Emergency, Cukurova University, Adana, Turkey

    Sevcan Bilen & Hayri Levent Yilmaz

  4. Faculty of Medicine, Department of Pediatric Intensive Care, Cukurova University, Adana, Turkey

    Ozden Ozgur Horoz, Faruk Ekinci, Ikbal Turker, Hasan Ali Telefon & Dincer Yildizdas

  5. Faculty of Medicine, Department of Biostatistics, Cukurova University, Adana, Turkey

    Ilker Unal

  6. Faculty of Medicine, Department of Neonatology, Cukurova University, Adana, Turkey

    Nejat Narli

Authors
  1. Bahriye Atmis
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  14. Dincer Yildizdas
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Bahriye Atmis, Aysun K. Bayazit, Cagla Cagli Piskin, Emel Saribas, Ferhat Can Piskin, Sevcan Bilen, Ilker Unal and Dincer Yildizdas. The first draft of the manuscript was written by Bahriye Atmis and Aysun K. Bayazit, all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Bahriye Atmis.

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Ethics approval

All procedures involving human participants were performed in accordance with the ethical standards of the institutional and/or national research committee, in addition to the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. The study was approved by the Ethical Committee of the University Medical Faculty (05–05-2023–133/12).

Competing interests

The authors declare no competing interests.

Additional information

Communicated by Gregorio Milani

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Atmis, B., Bayazit, A.K., Cagli Piskin, C. et al. Factors predicting kidney replacement therapy in pediatric earthquake victims with crush syndrome in the first week following rescue. Eur J Pediatr 182, 5591–5598 (2023). https://doi.org/10.1007/s00431-023-05250-3

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  • DOI: https://doi.org/10.1007/s00431-023-05250-3

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