CANSES OF MORTALITY IN CRUSH SYNDROME

Acute renal failure (ARF) is one of the most important predictors of mortality in Crush syndrome. The aim of our study was to investigate the early predictors of in-hospital mortality in patients presenting with myoglobutinuric ARF due to traumatic rhabdomyolysis. During the Marmara and Düzce earthquakes, out of 519 victims presenting to our hospital, 89 had myoglobulinuric ARF due to crush injury (17.14%), and 59 required hemodialysis (66.3 %). 19 patients died during the hospitalisation period (3.6%); 9 (7M;2F/ mean age:43.4+12) of whom had myoglubulinuric acute renal failure. Patients with crush syndrome who died were older (p<0.05), had more extensive injuries, underwent amputations and/or fasciotomies more than those patients who survived (p<0.05). Urine output within the first 8 hours of admission was less inpatients who died than the survivors (p<0.05) and the need for dialysis was more. (P<0.05). While no significant difference was found between the survivors and non-survivors with regard to their, serum creatinine, blood urea nitrogen (BUN), aspartat amino transferase (AST) levels, potassium levels were higher, hematocrite and thrombocyte levels were lower in patients who died compared to those who survived (p<0.05). When compared for the highest follow-up values, BUN, AST, creatine kinase (CK) and potassium levels were significantly higher in patients who died.(p<0.05). 5 of these patients died in the first week, 4 of them died after the 4th week. Early mortality causes were excessive crush injury with cranial or thoracic trauma, while the cause was sepsis following the 4th week. In conclusion advanced age, the extent of injured body area, presence of amputation and/or fasciotomy and renal replacement therapy requirement, were factors increasing the mortality. Higher potassium levels, lower hematocrite and thrombocyte levels, lesser urine out put in the first 8 hours may be early predictors of mortality in patients with crush syndrome.