Crush Sendromunda mortaliteye etki eden faktörler

AMAÇ: Crush Sendromu, büyük ölçekli katastrofik depremlerden sonra morbidite ve mortalitenin en önemli nedenlerinden biridir. Ezilme Sendromu ile ilgili randomize kontrollü bir çalýþma bulunmadýðýndan, bu konudaki bilgiler uzmanlarýn deneyimleriyle sýnýrlýdýr. Bu çalýþmanýn temel amacý, 06 Þubat 2023 tarihinde meydana gelen Pazarcýk ve Elbistan depremleri sonrasýnda depremzedelerin epidemiyolojik, demografik özelliklerini, klinik sonuçlarýný ve mortalite faktörlerini analiz etmektir
GEREÇ VE YÖNTEM: Bu kesitsel ve gözlemsel retrospektif çalýþmada, 6 Þubat - 30 Nisan 2023 tarihleri arasýnda merkezimize baþvuran 610 depremzede deðerlendirildi. Bu hastalar arasýnda Crush Sendromu olan 128 hasta çalýþmaya dahil edildi. Hastalara ait bilgiler, hastaneye yatýþlarý sýrasýnda hastane kayýtlarýndan ve sevk edildiklerinde ulusal kayýtlardan elde edildi. Birincil sonucumuz mortalite için risk faktörlerini belirlemekti. Demografik ve laboratuvar verileri akut böbrek hasarý evrelerine göre karþýlaþtýrýldý; mortaliteyi etkileyen faktörler regresyon analizi ile belirlendi.
BULGULAR: 128 Crush Sendromu hastasýnýn (100 yetiþkin, 28 çocuk) 64'ü kadýndý. AKI oraný %32.8 idi. AKI hastalarý arasýnda hemodiyaliz gereksinimi sýklýðý %69 ve mortalite oraný %14.2 idi. Ölüm oraný Crush Sendromu olanlarda %4.6 iken, Crush Sendromu olmayan depremzedelerde %3.9 (19/482) idi. (p: 0.705) Çarpýcý bir þekilde, Crush sendromlu hastalarda mortaliteyi önemli ölçüde etkileyen sadece baþvuru sýrasýndaki düþük sistolik kan basýncýdýr. (HR: 1.088, p: 0.021 %95 C.I.)
SONUÇ: Çalýþmamýz, baþvuru sýrasýndaki düþük sistolik kan basýncýnýn Crush Sendromlu hastalarda artmýþ mortalite için önemli bir risk faktörü olduðunu vurgulamýþtýr. Bu sonuç, enkaz altýnda kan basýncýnýn ölçülmesi ve düþük sistolik kan basýncý olan hastalara daha agresif sývý tedavisi verilmesi konusunda literatüre katký saðlayabilir

Mortality Factors in Crush Syndrome

BACKGROUND: Crush Syndrome is a major cause of morbidity and mortality following large-scale catastrophic earthquakes. Since there are no randomized controlled studies on Crush Syndrome, knowledge on this subject is limited to expert experience. The primary objective is to analyze the epidemiological and demographic characteristics, clinical outcomes, and mortality factors of earthquake victims after the Pazarcik and Elbistan earthquakes on February 6, 2023.
METHODS: This cross-sectional and observational retrospective study evaluated 610 earthquake victims who presented to our center between February 6 and April 30, 2023. Among these patients, 128 with Crush Syndrome were included in the study. Patient information was gathered from hospital records during their stay and from national registries upon referral. The primary outcome was to identify risk factors for mortality. Demographic and laboratory data were analyzed by acute kidney injury (AKI) stages; mortality-affecting factors were identified through regression analysis.
RESULTS: Of the 128 Crush Syndrome patients (100 adults, 28 children), 64 were female. The AKI rate was 32.8%. Among patients with AKI, the frequency of hemodialysis requirement was 69%, and the mortality rate was 14.2%. The overall mortality rate for patients with Crush Syndrome was 4.6%, compared to 3.9% (19/482) in earthquake victims without Crush Syndrome (p=0.705). Notably, low systolic blood pressure at admission was the only factor significantly affecting mortality in Crush Syndrome patients (Hazard Ratio [HR]: 1.088, p=0.021, 95% Confidence Interval [CI]).
CONCLUSION: Our study highlights low systolic blood pressure upon admission as a significant risk factor for increased mortality in Crush Syndrome patients. This finding may contribute to the literature by emphasizing the importance of monitoring blood pressure under rubble and administering more aggressive fluid therapy to patients with low systolic blood pressure.