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CRUSH SENDROMUNDA MORTALITE NEDENLERİ

CANSES OF MORTALITY IN CRUSH SYNDROME

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Abstract (2. Language): 
Acute renal failure (ARF) is one of the most important predictors of mortality in Crush syndrome. The aim of our study was to investigate the early predictors of in-hospitalmortality in patients presenting with myoglobutinuric ARF due to traumatic rhabdomyolysis. During the Marmara and Düzce earthquakes, out of 519 victims presenting to our hospital, 89 had myoglobulinuric ARF due to crush injury (17.14%), and 59 required hemodialysis (66.3 %). 19patients died during the hospitalisation period (3.6%); 9 (7M;2F/mean age:43.4+12) of whom had myoglubulinuric acute renal failure. Patients with crush syndrome who died were older (p<0.05), had more extensive injuries, underwent amputations and/or fasciotomies more than those patients who survived (p<0.05). Urine output within thefirst 8hours of admission was less inpatients who died than the survivors (p<0.05) and the need for dialysis was more. (P<0.05). While no significant difference wasfound between the survivors and non-survivors with regard to their, serum creatinine, blood urea nitrogen (BUN), aspartat amino transferase (AST) levels, potassium levels were higher, hematocrite and thrombocyte levels were lower in patients who died compared to those who survived (p<0.05). When compared for the highest follow-up values, BUN, AST, creatine kinase (CK) and potassium levels were significantly higher in patients who died.(p<0.05). 5ofthese patients died in thefirst week, 4 ofthem died after the 4th week. Early mortality causes were excessive crush injury with cranial or thoracic trauma, while the cause was sepsis following the 4th week. In conclusion advanced age, the extent of injured body area, presence of amputation and/or fasciotomy and renal replacement therapy requirement, were factors increasing the mortality. Higher potassium levels, lower hematocrite and thrombocyte levels, lesser urine out put in the first 8 hours may be early predictors of mortality in patients with crush syndrome.
Abstract (Original Language): 
Crush sendrom'unda mortaliteyi belirleyen en önemli nedenlerden biri akut böbrek yetmezliğidir. Çalışmamızın amacı, hastanemize başvuran travmatik rabdomiyolize bağlı miyoglobulinürik akut böbrek yetmezlikti hastalarda hastane mortalitesinin olası erken belirteçlerini saptamaktı. Marmara ve Düzce depremleri sırasında hastanemize başvuran 519 depremzedenin 89'unda ezilme hasarına bağlı miyoglobulinürik akut böbrek yetmezliği (ABY) gelişti (%17.14), bunların 59'unda ise diyaliz gereksinimi oldu (%66.3). Hastanemizde izlenen depremzedelerin I9'u hastane izlemisırasında öldü (%3.6). Ölen hastaların 9'u (7E;2K,ort.yaş: 43.4+12yıl) miyoglobulinürik ABYile takip edilen hastalardı. Ölen crush sendromlu hastalar sağ kalanlardan daha yaşlı (p<0.05); hasarlı vücut alanları daha yaygın (p<0.05) veamputasyon ve/veya fasiyotomigereksinimi daha fazla olan hastalardı (p<0.05). Ölen crush sendromlularda hastaneye yatışlarının ilk 8 saatindeki idrar çıkışı yaşayan hastalardan daha azdı (p<0.05) ve diyaliz gereksinimi daha fazla idi(p<0.05).Başvuruda bakılan serum kreatinin, kan üre azotu (BUN), aspartatamino tranferaz (AST) değerleri ölenlerle yaşayanlar arasında farklılık göstermezken, potasyum düzeyleri daha yüksek, hematokrit ve trombositsayısı ise anlamlı olarak daha düşüktü (p<0.05). Bu hastaların izlemi sırasında elde edilen en yüksek veriler ele alındığında BUN, AST, kreatin kinaz (CK) ve potasyum düzeyleri ölen hastalarda daha yüksek bulundu (p<0.05). Ölen hastaların 5'i birinci haftada, 4'ü de dördüncü haftada kaybedildi. Erken mortalite nedenleri kraniyal ve toraks travmalarını da içeren yaygın crush trauması, iken dördüncü haftadan sonraki mortalitenin temel nedeni sepsisti. Sonuç olarak, bu çalışmada; crush sendromu ile hastane izlemindeki hastalarda ileri yaş, hasarlı vücut alanının yaygınlığı, amputasyon ve/veya fasiyotomi ve renal replasman tedavisi gereksinimi mortaliteyi arttıran faktörlerdir. Yüksek potasyum, düşük hematokrit ve trombosit değerleri ve ilk 8 saatte idrar miktarının azlığı mortalitenin erken belirteçleri olabilir.
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