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Multicenter Study
. 2025 Jun 8;26(1):284.
doi: 10.1186/s12882-025-04183-3.

Pre-earthquake kidney function is a predictor of outcomes in earthquake-related crush syndrome

Ramazan Daniş  1 , Savaş Öztürk  2 , İsmail Koçyiğit  3 , Jehat Kılıç  4 , Merve Civan  5 , Tuncay Şahutoğlu  6 , Dilek Torun  7 , Engin Onan  7 , Ahmet Alper Kıykım  8 , Simal Köksal Cevher  9 , Gürsel Yıldız  10 , Zeynep Ebru Eser  11 , Fatma Betül Güzel  12 , Süleyman Karaköse  13 , Tolga Yıldırım  14 , Mehmet Polat  15 , Ebru Gök Oğuz  16 , Ali Gürel  17 , Yasemin Coşkun Yavuz  18 , Hasan Kayabaşı  19 , Zehra Eren  20 , Mehmet Rıza Altıparmak  21 , Nurhan Seyahi  21 , Mehmet Küçüksu  22 , Sibel Gökçay Bek  23 , Esra Akçalı  24 , İrem Pembegül  25 , Zeki Aydın  26 , Elif Arı Bakır  27 , Saliha Yıldırım  28 , Sabahat Ecder  29 , Mehmet Horoz  30 , Funda Sarı  31 , Yavuz Ayar  32 , Murat Tuğcu  33 , Ayça İnci  34 , Numan Görgülü  35 , Nedim Yılmaz Selçuk  36 , Gülizar Şahin  37 , Cuma Bülent Gül  38 , Hamat Dheir  39 , Özdem Kavraz  40 , Abdülkadir Ünsal  41 , Sedat Üstündağ  42 , Ali Rıza Odabaş  37 , Serhan Tuğlular  33
Affiliations
Multicenter Study

Pre-earthquake kidney function is a predictor of outcomes in earthquake-related crush syndrome

Ramazan Daniş et al. BMC Nephrol. .

Abstract

Background: The devastating earthquakes in Kahramanmaraş, Türkiye, in February 2024, caused extensive trauma and loss of lives, causing unique challenges in the management of earthquake-related crush syndrome. The current study investigates the prognostic value of pre-earthquake kidney function for mortality prediction in patients diagnosed with crush syndrome.

Methods: A multi-center retrospective analysis was performed using data from 469 patients treated at 46 nephrology clinics. Pre-earthquake Kidney function, defined by serum creatinine and estimated glomerular filtration rate (eGFR) levels, was obtained from pre-earthquake health records. Clinical findings, laboratory parameters, complications, and survival probabilities were analyzed. Multivariate Cox regression was used to identify independent predictors of in-hospital mortality.

Results: The mean age of participants was 42.56 ± 16.92 years (Non-survivors: 50.46 ± 20.03 years, Survivors: 42.34 ± 16.80 years (p = 0.172)). The in-hospital mortality rate was 2.8%. Non-survivors exhibited significantly higher pre-earthquake creatinine levels than survivors (1.04 ± 0.61 mg/dL vs. 0.77 ± 0.33 mg/dL, p = 0.03), with lower eGFR (85.2 ± 34.7 mL/min/1.73 m² vs. 115.8 ± 39.4 mL/min/1.73 m², p = 0.008). Compared with survivors, non-survivors had higher incidences of AKI (92.3% vs. 61.6%, p = 0.037) and more severe metabolic disturbances, including hyperkalemia (5.41 ± 1.72 mmol/L vs. 5.13 ± 0.98 mmol/L, p = 0.008). Regression analysis revealed that pre-earthquake creatinine (HR: 9.121, 95% CI: 2.686-30.970, p < 0.001) and potassium levels at admission (HR: 3.338, 95% CI: 1.540-7.232, p = 0.002) were independent predictors of mortality.

Conclusions: Pre-earthquake kidney function significantly predicts mortality in crush syndrome patients, highlighting the importance of baseline kidney assessment in disaster preparedness.

Keywords: Crush syndrome; Türkiye; acute kidney injury; disaster nephrology; hyperkalemia; kidney function; mortality.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: The study was conducted in accordance with the Declaration of Helsinki. The study protocol received approval from the Clinical Research Ethics Committee of Istanbul University, Istanbul Faculty of Medicine (Decision date/no: 17.02.2023/04). Written consent was not obtained with the ethics committee’s knowledge. Clinical trial number: Not applicable. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
ROC analysis for previous serum creatinine in predicting mortality
See this image and copyright information in PMC

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