Epidemiological analysis of the victıms wıth crush syndrome in earthquakes of southeastern Turkey
İlyas Öztürk, Özkan Güngör, Savaş Öztürk, Refik Olmaz, Ayse Jini Günes Keskin, İsmail Koçyiğit, Murat Hayri Sipahioğlu, Fatih Dede, Sena Ulu, Kenan Turgutalp, Di̇lek Torun, Tuncay Şahutoğlu, Mehmet Fatih Erdur, Orçun Altunören, Ramazan Danış, Gürsel Yıldız, Ali Gürel, Mehmet Horoz, Mehmet Küçüksu, Süleyman Karaköse, Tolga Yıldırım, Mehmet Rıza Altıparmak, Mehmet Deniz Aylı, Murat Tuğçu, Zehra Eren, Eray Eroğlu, Yasemin Coşkun Yavuz, Esra Akçalı, Dede Şit, Mehmet Polat, Saliha Yıldırım, Selma Alagöz, Sibel Gökçay Bek, İrem Pembegül, Tahsin Karaaslan, Mustafa Keleş, Funda Sarı, Üstün Yılmaz, Numan Görgülü, Gülizar Manga Şahin, Zeki Aydın, Serap Yadigar, Özkan Ulutaş, Nedim Yılmaz Selçuk, Yavuz Ayar, Didem Turgut, Özgür Akın Oto, Mehmet Koç, Alaattin Yıldız, Serhan Tuğlular, Mehmet Şükrü Sever
Abstract
Each year, millions face natural disasters, encountering mass fatalities and severe medical issues such as crush injuries and crush syndrome. Crush syndrome, marked by acute kidney injury (AKI) and hyperkalemia, correlates with mortality. This study focuses on presenting epidemiological data on kidney disease resulting from the February 6, 2023 earthquakes centered in Kahramanmaras. This retrospective analysis included patients diagnosed with crush syndrome after the 2023 Kahramanmaras earthquakes, treated in regional hospitals or referred elsewhere in Turkey. Patient data were documented using the web-based system developed by the Turkish Nephrology Association Renal Disaster Working Group. Of the 1024 analyzed patients from 46 centers, 515 (50.3%) were women. The mean age was 41 ± 16 years, with a median duration of 12 h under rubble, and the median presentation time to the first health facility was 4 h after extrication from the rubble. Upon admission, 79.8% received intravenous fluid therapy, all potassium-free. Initial serum creatinine, K+, and creatinine kinase levels averaged 2.59 ± 2 mg/dl, 5.1 ± 1 mmol/L 38,305 ± 54,303 U/L, respectively. Intensive care unit (ICU) admissions were 53.6%, with mean hospital and ICU stays of 20 and 11 days, respectively. Compartment syndrome occurred in 40.8% of patients, with 75.8% undergoing fasciotomy. Acute kidney injury developed in 67.9% of patients, with 70.3% undergoing hemodialysis, totaling 3016 sessions on 488 patients. The overall in-hospital mortality rate was 9.8%. Earthquakes have a significant impact on kidney health. Although our study indicates some progress compared to previous earthquake responses, there remains a crucial need for drills emphasizing post-earthquake initial response, fluid-electrolyte balance management, and emergency dialysis protocols.