Impact of crush syndrome severity on clinical outcomes after the earthquakes in southeastern Türkiye

Crush syndrome is a potentially life-threatening complication of prolonged compression injuries, frequently encountered after earthquakes. The 2023 Kahramanmaraş earthquakes in Türkiye 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. 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. 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. 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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Journal
BMC Nephrology
Published
2026-02-04
DOI
https://doi.org/10.1186/s12882-026-04757-9
Primary Topic
Muscle and Compartmental Disorders
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article
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article

Impact of crush syndrome severity on clinical outcomes after the earthquakes in southeastern Türkiye

Numan Görgülü, Ayça İnci, Fatma Betül Güzel, Zehra Eren et al.
BMC Nephrology
Muscle and Compartmental Disorders
article

Impact of crush syndrome severity on clinical outcomes after the earthquakes in southeastern Türkiye

Numan Görgülü, Ayça İnci, Fatma Betül Güzel, Zehra Eren, Murat Tuğçu, Mehmet Horoz, Nergiz Bayrakçi, Mürşide Esra Dölarslan, Tahsin Karaaslan, Meliha Ozkutlu, Murat Hayri Sipahioğlu, Şükrü Öztürk, Bahar Gürlek Demirci, Sena Ulu, Funda Sari, Ayhan DOĞUKAN, Tuncay Şahutoğlu, Ahmet Kıykım, Mahmut Şükrü Gök, Di̇lek Torun, Kübra Aydın, Sedat Alagöz, Emrah Erkan Mazı, Ayşe Serra Artan, Süleyman Karaköse, S. Tuglular, Gürsel YILDIZ, Mehmet Küçüksu, Kübra KAYNAR, Engin Onan, Mehmet Polat, Neriman Sila Koç, Yavuz Ayar, S. G. Bek, Dede Şit, Ozlem Usalan, Saliha Yildirim, Mehmet Riza Altiparmak, Mehmet Deniz Ayli, Ramazan DANİS, Ali Gurel, Didem Turgut, Irem Pembegul, Zeynep Ebru Eser, Tolga Yildirim, Nedim Yilmaz Selcuk, Serap Demir, Zeki Aydin, Kenan Turgutalp, Esra Akcali, Murathan Uyar
article en

Abstract

Crush syndrome is a potentially life-threatening complication of prolonged compression injuries, frequently encountered after earthquakes. The 2023 Kahramanmaraş earthquakes in Türkiye 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. 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. 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. 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.

BMC NephrologyVol. 27(1)
Tekirdağ Namık Kemal University (TR), Fırat University (TR), Karadeniz Technical University (TR), University of Health Science (KH), Istanbul Aydın University (TR), Başkent University (TR), Akdeniz University (TR), Mardin Artuklu University (TR), Konya Food and Agriculture University (TR), State Hospital (GB), Memorial Ankara Hospital (TR), Dr Lütfi Kırdar Kartal Eğitim ve Araştırma Hastanesi (TR), Necmettin Erbakan University (TR), Sivas State Hospital (TR), Antalya Eğitim ve Araştırma Hastanesi (TR), Ümraniye Eğitim ve Araştırma Hastanesi (TR), Malatya Turgut Özal Üniversitesi (TR), Nevşehir Hacı Bektaş Veli University (TR), Istanbul University-Cerrahpaşa (TR), Bağcılar Eğitim ve Araştırma Hastanesi (TR), Alanya University (TR), Şanlıurfa Mehmet Akif İnan Eğitim ve Araştırma Hastanesi (TR), Başkent University Hospital (TR), Sağlık Bilimleri Üniversitesi (TR), Tarsus University (TR), Elazığ Eğitim ve Araştırma Hastanesi (TR), İstanbul Kanuni Sultan Süleyman Eğitim ve Araştırma Hastanesi (TR), Fatih Sultan Mehmet Eğitim Ve Araştırma Hastanesi (TR), S.B.Ü. Bursa Yüksek İhtisas Eğitim ve Araştırma Hastanesi (TR), Kahramanmaraş Sütçü İmam University (TR), Adana Science and Technology University (TR), Mersin Üniversitesi (TR), Kocaeli Üniversitesi (TR), Gaziantep University (TR), Turgut Özal University (TR), Hacettepe University (TR), Istanbul University (TR), Marmara University (TR), Harran University (TR), University of Health Sciences Antigua (AG), Erciyes University (TR), Gazi University (TR)
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