ArticleEuropean journal of trauma and emergency surgery : official publication of the European Trauma Society2025
CK/Albumin and K/Ca ratios as predictors of clinical severity and renal replacement therapy in pediatric crush syndrome.
Article in European journal of trauma and emergency surgery : official publication of the European Trauma Society, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundCrush syndrome after earthquakes is life-threatening. In pediatric patients, prognostic indicators for severe course and renal replacement therapy (RRT) remain unclear. We evaluated the prognostic value of creatine kinase (CK)/albumin and potassium/calcium (K/Ca) ratios in pediatric crush syndrome following the 2023 Kahramanmaraş earthquake.
methodsThis retrospective study included patients aged 1 month-18 years admitted to the Pediatric Intensive Care Unit (PICU) of Kayseri City Hospital between February 6 and March 6, 2023. Patients requiring fasciotomy, amputation, or who died were classified as severe; RRT was analyzed separately. Statistics included Mann-Whitney U, Fisher's Exact, Spearman correlation, and ROC analysis with cut-offs determined by the Youden J index.
resultsThirty-eight patients were included; 23 (60.5%) were male. Severe course occurred in 27 (71.1%); 11 (28.9%) required RRT. Amputation was performed in 11 (28.9%), fasciotomy in 26 (68.4%); mortality was 7.9%. Severe cases had higher CK/Albumin, CK, and PICU stay (all p < 0.05). Patients requiring RRT had higher CK/Albumin and K/Ca ratios, CK, age, PICU stay, and ventilation duration (all p < 0.05). ROC analysis showed CK/Albumin predicted severe course at 3890.7 (AUC = 0.77, p = 0.007) and CK at 20,450 U/L (AUC = 0.75, p = 0.011). For RRT, CK/Albumin 19,162 (AUC = 0.82, p < 0.001) and K/Ca 0.57 (AUC = 0.92, p < 0.001) were significant; K/Ca showed 100% sensitivity and NPV.
conclusionCK/Albumin and K/Ca ratios are valuable prognostic biomarkers in pediatric crush syndrome. CK/Albumin reflects muscle injury and inflammation, while K/Ca is the strongest predictor of RRT. These parameters may aid early risk stratification in disaster-related pediatric trauma and support triage in clinical practice.
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