A retrospective analysis of ICU follow-up of earthquake victims revealed a high rate of acute kidney injury. Most of these patients received renal replacement therapy. A total of 77% patients underwent surgical procedures, with the majority (36%) requiring extremities surgery, including fasciotomy, due to compartment syndrome. Additionally, 24% patients underwent extremity amputation. The mNUTRIC score, serum BUN and blood lactate level were identified as independent risk factors for 28-day mortality in a Cox regression model.
Patients who have been affected by major natural disasters, such as earthquakes, should be treated in well-equipped health centers staffed by multidisciplinary teams. In some cases, there may not be any multidisciplinary hospitals around the earthquake, or the earthquake may affect the area in which hospitals are available. In 1999, the most developed region of Turkey was hit by a devastating earthquake in the Marmara region. A medical unit of the Medical Corps of the Israeli Defense Forces providing intensive care in the setting of a field hospital, deployed to the site of a major urban disaster(10). The 12-bed intensive care unit was run by the unit. It was staffed by three doctors and eight nurses/paramedics. The patient mix was a total of 63 patients, including five major trauma, 20 acute cardiac, 15 various acute illnesses and 11 surgical and post-operative patients. The 6 February 2023 earthquake in Turkey, which occurred in the south-eastern region, had a minimal impact on the country's health system. Those who were injured in the earthquake were transported to hospitals across the country, with the majority being treated in nearby cities. The city of Kayseri borders on the city of Kahramanmaras, the epicenter of the earthquake. The results of this analysis show that patients with crush injuries underwent many surgical procedures. A large proportion of patients underwent RRT, and some were placed on mechanical ventilators. Although the earthquake was felt, the health system was not affected. Patients from the earthquake zone were successfully treated.
A retrospective analysis of patients who had been affected by the 1999 Marmara earthquake, which occurred 24 years prior to the Kahramanmaraș earthquake, revealed that (13 patients) 72% of those who were under intensive care for renal failure ultimately required haemodialysis, as reported by Demirkıran et al(5). In a study of the cases of the Great Marmara earthquake, Kazancıoğlu et al. examined 60 patients diagnosed with crush syndrome and found that 40 patients (66%) had developed renal failure necessitating dialysis(11). In 2008, 32 ICU patients affected by the Wuhan earthquake in China were evaluated. Of these patients, 53% developed crush injury syndrome and 34% developed acute renal failure. A total of 18% of these patients died (4). Similar to our patients, a high rate of renal damage is observed in patients with crush injury, as seen in all of the above studies.
Organ amputations, especially of the lower limbs, are a significant condition that affects both the ICU and the life of the victims after the ICU. Analyses of patient data following major earthquakes around the world have shown that over 20% of organs were amputated (5, 12, 13). The study found a 24% rate of limb amputation. High APACHE II and SOFA scores were found to be associated with increased risk of amputation. In the above analyses, it is noted that patients had multiorgan failure same as our study.
The health facilities in the region where the earthquake occurred may be important in assessing the in-hospital mortality of people affected by the earthquake(14–17). The mortality rate for these patients is over 50%. Mortality rates are higher in patients with crush syndrome, need for renal replacement therapy, shock and need for multiple surgeries(4, 15, 18). In this analysis, the presence of malnutrition and high levels of BUN and lactate in the blood were found to be independent risk factors for 28-day mortality. The relationship between malnutrition and mortality in earthquake patients requiring intensive care has not been studied. In this study, the relationship between the mNUTRIC score and mortality was determined for the first time. A study of patients affected by the Kahramanmaraş earthquake but taken to hospitals in another city, Adana, found higher blood BUN and lactate levels in patients who died(18).
This study has some limitations. There is no information on how long the patients were under the collapsed building. But all these patients were treated within the first 48 hours after the earthquake. The other limitation is the relatively small number of patients. These results cannot be generalized.