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    Epidemiological analysis of the victıms wıth crush syndrome in earthquakes of southeastern Turkey
    (Springer Heidelberg, 2024) Ozturk, Ilyas; Gungor, Ozkan; Ozturk, Savas; Olmaz, Refik; Keskin, Ayse Jini Gunes; Kocyigit, Ismail; Sipahioglu, Murat Hayri
    BackgroundEach year, millions face natural disasters, encountering mass fatalities and severe medical issues such as crush injuries and crush syndrome. Crush syndrome, marked by acute kidney injury (AKI) and hyperkalemia, correlates with mortality. This study focuses on presenting epidemiological data on kidney disease resulting from the February 6, 2023 earthquakes centered in Kahramanmaras.MethodsThis retrospective analysis included patients diagnosed with crush syndrome after the 2023 Kahramanmaras earthquakes, treated in regional hospitals or referred elsewhere in Turkey. Patient data were documented using the web-based system developed by the Turkish Nephrology Association Renal Disaster Working Group.ResultsOf the 1024 analyzed patients from 46 centers, 515 (50.3%) were women. The mean age was 41 +/- 16 years, with a median duration of 12 h under rubble, and the median presentation time to the first health facility was 4 h after extrication from the rubble. Upon admission, 79.8% received intravenous fluid therapy, all potassium-free. Initial serum creatinine, K+, and creatinine kinase levels averaged 2.59 +/- 2 mg/dl, 5.1 +/- 1 mmol/L 38,305 +/- 54,303 U/L, respectively. Intensive care unit (ICU) admissions were 53.6%, with mean hospital and ICU stays of 20 and 11 days, respectively. Compartment syndrome occurred in 40.8% of patients, with 75.8% undergoing fasciotomy. Acute kidney injury developed in 67.9% of patients, with 70.3% undergoing hemodialysis, totaling 3016 sessions on 488 patients. The overall in-hospital mortality rate was 9.8%.ConclusionEarthquakes have a significant impact on kidney health. Although our study indicates some progress compared to previous earthquake responses, there remains a crucial need for drills emphasizing post-earthquake initial response, fluid-electrolyte balance management, and emergency dialysis protocols.
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    Impact of crush syndrome severity on clinical outcomes after the earthquakes in southeastern Turkiye
    (Bmc, 2026) Turgutalp, Kenan; Ozturk, Savas; Koc, Neriman Sila; Dolarslan, Murside Esra; Kocyigit, Ismail; Turgut, Didem; Sahutoglu, Tuncay
    Background: Crush syndrome is a potentially life-threatening complication of prolonged compression injuries, frequently encountered after earthquakes. The 2023 Kahramanmara & scedil; earthquakes in Turkiye caused extensive crush-related trauma. The objective of this study was to assess the effect of baseline crush syndrome severity on hospitalization outcomes and complications. Methods: In this multicenter, retrospective observational study, 962 crush syndrome patients hospitalized after the earthquakes were evaluated. Patients were grouped as mild-moderate vs. severe-critical based on clinical presentation. Demographics, laboratory results, comorbidities, trauma types, complications, and outcomes were assessed. Comparisons between groups were performed using the Mann-Whitney U test and chi-square test, and survival analysis was conducted with the Kaplan-Meier method. Results: Of 962 patients, 232 (24.1%) were classified as severe-critical and 730 (75.9%) as mild-moderate. Severe-critical patients had significantly higher rates of hypotension (38.8% vs 2.3%), ARDS (10.2% vs 1.7%), sepsis (31.7% vs 9.1%), DIC (8.5% vs 1.4%), arrhythmias (11.9% vs 0.8%), compartment syndrome (53.5% vs 36.9%), and ICU (95.6% vs 40.9%) requirement than mild-moderate (all p<0.001). Laboratory markers including BUN, creatinine, potassium, phosphorus, liver enzymes, CK, and CRP were all significantly elevated, while calcium and albumin levels were lower in the severe-critical group (p<0.05). Kaplan-Meier analysis revealed a significantly lower survival rate in the severe-critical group (67.7% vs. 97.7%, p<0.001). Trauma types such as cranial, abdominal, and thoracic injuries were more frequent in this group, and prolonged entrapment time [median 18 (8-40) vs. 10 (6-33) hours, p<0.05] was correlated with increased severity. Conclusions: Crush syndrome severity at admission is strongly correlated with clinical outcomes, complication rates, and in-hospital survival. Prolonged time under the rubble, systemic complications, and elevated muscle and renal injury markers contribute to worse prognosis. These findings highlight the need for rapid triage, timely fluid resuscitation, and organized multidisciplinary intervention in future disaster scenarios.
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    Patients with crush syndrome and kidney disease: lessons learned from the earthquake in Kahramanmaras,, Türkiye
    (Elsevier Science Inc, 2024) Ozturk, Savas; Tuglular, Serhan; Olmaz, Refik; Kocyigit, Ismail; Kibar, Muge Uzerk; Turgutalp, Kenan; Torun, Dilek
    This study investigated in-hospital outcomes and related factors in patients diagnosed with postearthquake crush syndrome after the earthquakes in Kahramanmaras,, T & uuml;rkiye. One thousand twenty-four adult patients diagnosed with crush syndrome were analyzed. and outcomes were collected. A total of 9.8% of patients died during their hospital stay. Nonsurvivors were generally older, more likely to have preexisting chronic kidney disease, and faced more severe injuries and complications, including hypotension-shock, arrhythmias, elevated markers of renal dysfunction, and higher rates of acute kidney injury (AKI) and compartment syndrome. In addition, intensive care unit needs were higher. Multivariate analysis confirmed that age, injury severity, shock, high potassium, uric acid, and lactate levels on admission, development of AKI, compartment syndrome, and intensive care unit admission were significant predictors of mortality. Better disaster preparedness and improved health care infrastructure could be potential explanations for improved in-hospital mortality in the current era, as compared to previous earthquakes.
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    Pre-earthquake kidney function is a predictor of outcomes in earthquake-related crush syndrome
    (Bmc, 2025) Danis, Ramazan; Ozturk, Savas; Kocyigit, Ismail; Kilic, Jehat; Civan, Merve; Sahutoglu, Tuncay; Torun, Dilek
    Background The devastating earthquakes in Kahramanmara & scedil;, T & uuml;rkiye, 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 m(2 )vs. 115.8 +/- 39.4 mL/min/1.73 m(2 ), 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.
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    Therapeutic plasma exchange in patients with neurologic diseases: Retrospective multicenter study
    (Pergamon-Elsevier Science Ltd, 2008) Kaynar, Leylagul; Altuntas, Fevzi; Aydogdu, Ismet; Turgut, Burhan; Kocyigit, Ismail; Hacioglu, Sibel Kabukcu; Ismailogullari, Sevda
    Therapeutic plasma exchange (TPE) is commonly used in many neurological disorders where an immune etiology was known or suspected. We report our experience with TPE performed for neuroimmunologic disorders at four university hospitals. The study was a retrospective review of the medical records of neurological patients (n = 57) consecutively treated with TPE between April 2006 and May 2007. TPE indications in neurological diseases included Guillain-Barre Syndrome (GBS) (n = 41), myasthenia gravis (MG) (n = 11), acute disseminated encephalomyelitis (ADEM) (n = 3), chronic inflammatory demyelinating polyneuropathy (CIDP) (n = 1) and multiple sclerosis (MS) (n 1). Patient median age was 49; there was a predominance of males. Twenty-two patients had a history of other therapy including intravenous immunoglobulin (IVIG), steroid, azothioprin, and pridostigmine prior to TPE. Another 35 patients had not received any treatment prior to TPE. All patients were classified according to the Hughes functional grading scores pre- and first day post-TPE for early clinical evaluation of patients. The TPE was carried out 1-1.5 times at the predicted plasma volume every other day. Two hundred and ninety-four procedures were performed on 57 patients. The median number of TPE sessions per patient was five, and the median processed plasma volume was 3075 mL for each cycle. Although the pre-TPE median Hughes score of all patients was 4, it had decreased to grade I after TPE. While the pre-TPE median Hughes score for GBS and MG patients was 4, post-TPE scores were decreased to grade 1. Additionally, there was a statistically significant difference between post-TPE Hughes score for GBS patients with TPE as front line therapy and patients receiving IVIG as front line therapy (1 vs. 3.5; p = 0.034). Although there was no post-TPE improvement in Hughes scores in patients with ADEM and CIDP, patients with MS had an improved Hughes score from 4 to 1. Mild and manageable complications such as hypotension and hypocalcemia were also observed. TPE may be preferable for controlling symptoms of neuroimmunological disorders in early stage of the disease, especially with GBS. (C) 2008 Elsevier Ltd. All rights reserved.