Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Jul 26;26(1):417.
doi: 10.1186/s12882-025-04318-6.

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

Zikret Koseoglu  1   2 , Deniz Gezer  3 , Ahmet Uzan  4
Affiliations

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

Zikret Koseoglu et al. BMC Nephrol. .

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.

Keywords: Acute kidney injury; Crush syndrome; Emergency department; Hemodialysis; Trauma; İnflammatory indices.

PubMed Disclaimer

Conflict of interest statement

Declarations. Ethics approval and consent to participate: The study was approved by the Clinical Research Ethics Committee of the University of Mersin (Ethics committee date and number: 27/11/2024, Decision No: 1156). Due to the retrospective nature of the study and the use of anonymized patient data, the need for individual participant consent was waived by the ethics committee in accordance with national regulations and the Declaration of Helsinki. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
The distribution of ROC analysis results evaluating the strength of NLR, PLR, LMR and SIII indices in predicting the need for hemodialysis, the development of acute kidney injury, and mortality in cases NLR: Neutrophil Lymphocyte Ratio; PLR: Platelet Lymphocyte Ratio; LMR: Lymphocyte Monocyte Ratio; SIII: Systemic Immune Inflammatory Index
See this image and copyright information in PMC

Similar articles

See all similar articles

References

    1. Ramírez-Guerrero G, Reis T, Marcello M, de Cal M, Ronco C. Crush syndrome-related acute kidney injury in earthquake victims, time to consider new therapeutical options? Int J Artif Organs. 2024;47(1):3–7. 10.1177/03913988231191954. - PubMed
    1. Sever MS, Vanholder R. Management of crush victims in mass disasters: highlights from recently published recommendations. Clin J Am Soc Nephrol. 2013;8(2):328–35. 10.2215/CJN.07340712. - PubMed
    1. Greaves I, Porter K, Smith JE. Consensus statement on the early management of crush injury and prevention of crush syndrome. J R Army Med Corps. 2004;150(3):102–6. 10.1136/jramc-149-04-02. - PubMed
    1. Burns K, Cone DC, Portereiko JV. Complex extrication and crush injury. Prehospital Emerg Care. 2010;14(2):240–4. 10.3109/10903120903564498. - PubMed
    1. Smith J, Greaves I. Crush injury and crush syndrome: a review. J Trauma Acute Care Surg. 2003;54(5):S226–30. 10.1097/01.TA.0000047203.00084.94. - PubMed

LinkOut - more resources