The efficiency of blood cell counts and inflammatory indices in prediction of need for acute kidney injury in patients with crush syndrome

Abstract

Background: Disasters are inevitable causes of trauma, resulting in a high number of deaths and morbidity in survivors requiring prolonged treatment. Crush syndrome (CS), also known as traumatic rhabdomyolysis, is a syndrome with a wide clinical spectrum. A series of clinical complications caused by CS, hyperkalemia, myoglobinuria and especially acute kidney injury (AKI) are the main causes of death. Objectives: This study has been designed to investigate the effectiveness of neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), lymphocyte-monocyte ratio (LMR) and systemic immune-inflammatory index (SIII) in predicting the need for hemodialysis (HD) in patients with CS following rescue from earthquake. Methods: This study was conducted as a single-center retrospective research. which focused on patients with CS among the earthquake victims who were admitted to the hospital after the earthquake centered in Southern Türkiye on February 6, 2023. Demographic, clinical and laboratory data of patients from the earthquake zone were used. T-Test was applied to compare two independent numerical variables. Receiver operating characteristic (ROC) curve analysis was used to assess the predictive capacity of NLR, PLR, LMR and SIII on AKI, HD and mortality (Area Under the Curve (AUC) > 0.600). The level of significance was accepted as p < 0.05. Results: Of the 464 patients included in the study, 45.3% (n = 210) were male and the mean age was 41.2 ± 15.9 years. The most common trauma mechanism was entrapment under debris (46.8%, n = 217). AKI was present in 42% (n = 195) of the cases and 30.1% (n = 140) required HD. The mortality rate was 7.3% (n = 34). The need for HD, hyperbaric therapy and blood replacement was significantly higher in patients who developed AKI (p < 0.001, p = 0.011 and p < 0.001, respectively). The predictive power of NLR on the need for hemodialysis, the development of AKI, and mortality was higher than PLR, LMR and SIII. In the ROC analysis to determine the need for hemodialysis, NLR (AUC = 0.828) was found to be higher in predicting power than PLR (AUC = 0.651), LMR (AUC = 0.787) and SIII (AUC = 0.792). Conclusions: Parameters obtained from blood cell counts such as NLR, PLR, LMR and SIII can be used to predict the severity of AKI and the need for hemodialysis in these patients rescued from earthquake. Clinical trial number: Not applicable.