The Prediction of 28-Day Mortality in Crush Syndrome by Evaluating Lactate/Albumin Ratio in Patients Presented to the Emergency Department After an Earthquake

Abstract

Introduction: Crush syndrome (CS) is a primary cause of mortality among survivors following earthquakes. Determining discharge outcomes and mortality in cases of CS is critical for guiding management strategies. Biomarkers may be utilized to predict survival and mortality in CS cases early and accurately; however, those currently used are primarily intended for disease diagnosis.

Objectives: Considering that cases associated with impaired vital signs and organ perfusion show alterations in lactate, albumin, and the lactate/albumin (L/A) ratio, it was hypothesized that the L/A ratio could serve as a prognostic and mortality predictor in CS cases.

Methods: Following the February 2023 Kahramanmaraş earthquake, 1145 trauma patients presenting to the hospital emergency department were evaluated. Among these, 62 patients meeting the inclusion criteria were diagnosed with CS. Patient records were retrieved from archives and the hospital management information system. Anamnesis, physical examination findings, laboratory results, consultations, and discharge summaries were retrospectively analyzed.

Results: A total of 62 CS cases meeting the inclusion criteria were included in the study. Upon evaluating the patients’ initial lactate, albumin, and L/A ratio levels, lactate and L/A ratio levels were significantly higher in the deceased group compared to the survivors, while albumin levels were significantly lower (p = 0.018, p = 0.003, and p = 0.007, respectively). To predict 28-day mortality, a cutoff value of 4.35 was determined for lactate with 73.3% sensitivity and 66% specificity (AUC: 0.735). For the L/A ratio, a cutoff value of 1.2 was identified with 86.7% sensitivity and 70.2% specificity (AUC: 0.811). For albumin, a cutoff value of 3.35 was established with 66% sensitivity and 60% specificity (AUC: 0.721). K, lactate, and albumin showed low correlation with mortality, whereas the L/A ratio demonstrated a moderate correlation with mortality.

Conclusion: The serum L/A ratio can serve as a guide in diagnostic decision making for the prediction of CS in patients, and the blood L/A ratio has been found to be a biomarker that can be used to predict 28-day mortality in patients with CS.