A new score predicting renal replacement therapy in patients with crush injuries: Analysis of a major earthquake

IF 2.7 3区 医学 Q1 EMERGENCY MEDICINE
Mustafa Comoglu, Fatih Acehan, Osman Inan, Burak Furkan Demir, Yusufcan Yılmaz, Enes Seyda Sahiner
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Abstract

Background

It is important to predict which patients may require renal replacement therapy (RRT) at the time of initial presentation after crush injuries. There is limited data in the literature examining the predictors of RRT.

Methods

This study was conducted by evaluating 2232 patients who presented to our hospital following two major earthquakes of magnitudes 7.6 and 7.7 Mw that occurred in Kahramanmaras, Turkey, on February 6, 2023. A total of 314 patients who were hospitalized upon being rescued from the rubble and had a creatine kinase (CK) level above 1000 U/L were included in the final analysis. Factors predicting the need for RRT were investigated, and a dialysis score was developed for this prediction.

Results

Of the 314 patients included in the study, 95 (30.2 %) developed acute kidney injury (AKI). RRT was performed on 68 (21.6 %) patients. The optimal cut-off value of CK for the prediction of AKI was 23,000 U/L. Multivariate analysis revealed that factors predicting RRT were the number of traumatized sides (odds ratio [OR]: 2.2, 95 % confidence interval [CI]: 1.09–4.39, p = 0.026), albumin (OR:0.11, 95 % CI: 0.04–0.32, p < 0.001), and CK (OR: 1.00, 95 % CI 1.00–1.00, p < 0.001). A dialysis score was developed ranging from 0 to 7 based on the number of traumatized sides, albumin, and CK. The area under the curve (AUC) of the dialysis score in receiver operating characteristic analysis was 0.974. A dialysis score of 4 or higher had a sensitivity of 97.1 % and a specificity of 89.4 % for predicting the need for RRT.

Conclusions

The dialysis score predicts the need for RRT quite well. The simplicity of use and high sensitivity and specificity of this score in earthquake-related crush injuries will greatly facilitate clinicians in patient triage and follow-up.
预测挤压伤患者肾脏替代治疗的新评分:大地震分析
背景:在挤压伤患者初次就诊时预测哪些患者可能需要肾脏替代治疗(RRT)非常重要。有关 RRT 预测因素的文献资料十分有限:本研究对 2023 年 2 月 6 日在土耳其卡赫拉曼马拉什(Kahramanmaras)发生的 7.6 级和 7.7 级大地震后送往本医院的 2232 名患者进行了评估。共有 314 名从废墟中被救出后住院的患者被纳入最终分析,这些患者的肌酸激酶 (CK) 水平高于 1000 U/L。研究调查了预测需要进行 RRT 的因素,并为此制定了透析评分标准:研究共纳入 314 名患者,其中 95 人(30.2%)出现急性肾损伤(AKI)。有 68 名患者(21.6%)接受了 RRT 治疗。预测 AKI 的最佳 CK 临界值为 23,000 U/L。多变量分析显示,预测 RRT 的因素包括创伤侧的数量(比值比 [OR]:2.2,95% 置信区间 [CI]:1.09-4.39,P = 0.026)、白蛋白(OR:0.11,95% 置信区间 [CI]:0.04-0.32,P 结论:RRT 的比值比 [OR]:2.2,95% 置信区间 [CI]:1.09-4.39,P = 0.026:透析评分能很好地预测 RRT 的需求。该评分在地震相关挤压伤中使用简单,灵敏度和特异性高,将极大地方便临床医生对患者进行分流和随访。
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来源期刊
CiteScore
6.00
自引率
5.60%
发文量
730
审稿时长
42 days
期刊介绍: A distinctive blend of practicality and scholarliness makes the American Journal of Emergency Medicine a key source for information on emergency medical care. Covering all activities concerned with emergency medicine, it is the journal to turn to for information to help increase the ability to understand, recognize and treat emergency conditions. Issues contain clinical articles, case reports, review articles, editorials, international notes, book reviews and more.
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