CK/Albumin and K/Ca ratios as predictors of clinical severity and renal replacement therapy in pediatric crush syndrome.

BACKGROUND

Crush 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.

METHODS

This 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.

RESULTS

Thirty-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.

CONCLUSION

CK/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.