Inflammation Indıces and Mortality in Adult Crush Syndrome

The Association of Systemic Inflammation-Based Hematological Indices With APACHE II, SOFA and 28-Day Mortality in Adult Crush Syndrome: A Retrospective Cohort Study

This retrospective observational cohort study aims to evaluate the prognostic value of inflammatory hematological indices, including neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio (MLR), systemic immune-inflammation index (SII), systemic inflammatory response index (SIRI), and pan-immune-inflammation value (PIV), in predicting 28-day mortality in adult patients with crush syndrome admitted to the intensive care unit (ICU).

Patients aged 18 years and older diagnosed with crush syndrome between January 1, 2018, and September 30, 2025, were included. The primary outcome is 28-day mortality. Secondary outcomes include ICU mortality and in-hospital mortality. The predictive performance of inflammatory indices will be compared with established severity scores such as APACHE II and SOFA.

Study Overview

• Status: Completed
• Conditions: Critical Illness; Rhabdomyolysis; Systemic Inflammatory Response; Crush Syndrome

Detailed Description

Crush syndrome is a life-threatening condition characterized by severe muscle injury, systemic inflammatory response, acute kidney injury, and high mortality, particularly in disaster-related mass trauma settings. Early risk stratification is crucial for optimizing intensive care management and resource allocation.

This retrospective cohort study includes adult patients (≥18 years) diagnosed with crush syndrome and admitted to the intensive care unit of Ataturk University Hospital between January 1, 2018, and September 30, 2025. Demographic data, laboratory parameters, and clinical severity scores were obtained from electronic medical records.

Inflammatory indices calculated from complete blood count parameters include:

• Neutrophil-to-lymphocyte ratio (NLR)
• Platelet-to-lymphocyte ratio (PLR)
• Monocyte-to-lymphocyte ratio (MLR)
• Systemic immune-inflammation index (SII)
• Systemic inflammatory response index (SIRI)
• Pan-immune-inflammation value (PIV)

The primary endpoint is 28-day mortality following ICU admission. Secondary endpoints include ICU mortality and in-hospital mortality. Multivariate logistic regression and receiver operating characteristic (ROC) curve analyses will be performed to assess the independent prognostic value of inflammatory indices compared with established scoring systems such as APACHE II and SOFA.

The study aims to determine whether readily available hematological indices provide additional prognostic value in critically ill patients with crush syndrome.

• Study Type: Observational
• Enrollment (Actual): 325

Contacts and Locations

Study Locations

• Turkey (Türkiye)
  • Erzurum, Turkey (Türkiye), 20100
    • Atatürk University Research Hospital

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

• Sampling Method: Non-Probability Sample

Study Population

Adult patients diagnosed with crush syndrome and admitted to the intensive care unit of Ataturk University Hospital between January 2018 and September 2025.

Description

Inclusion Criteria:

• Age ≥18 years
• Diagnosis of crush syndrome based on clinical and laboratory findings
• Admission to the intensive care unit (ICU) between January 1, 2018 and September 30, 2025
• Availability of complete blood count parameters within the first 24 hours of ICU admission

Exclusion Criteria:

• Age <18 years
• Incomplete medical records
• Missing laboratory data required for calculation of inflammatory indices
• Patients discharged or transferred within 24 hours of ICU admission

Study Plan

How is the study designed?

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
28-day All-Cause Mortality	All-cause mortality occurring within 28 days after intensive care unit (ICU) admission in adult patients diagnosed with crush syndrome.	28 Days

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
ICU Mortality	Death occurring during the intensive care unit stay.	During ICU stay (up to 28 days)
In-Hospital Mortality	All-cause mortality occurring during the index hospital admission.	During hospital stay (up to 90 days)

Collaborators and Investigators

• Sponsor: Ataturk University

Study record dates

Study Major Dates

• Study Start (Actual): January 1, 2018
• Primary Completion (Actual): October 28, 2025
• Study Completion (Actual): October 28, 2025

Study Registration Dates

• First Submitted: February 19, 2026
• First Submitted That Met QC Criteria: February 19, 2026
• First Posted (Actual): February 25, 2026

Study Record Updates

• Last Update Posted (Actual): February 25, 2026
• Last Update Submitted That Met QC Criteria: February 19, 2026
• Last Verified: February 1, 2026

More Information

Terms related to this study

• Keywords: Intensive Care Unit; MLR; PLR; NLR; APACHE II; PIV; Neutrophil-to-Lymphocyte Ratio; SOFA SCORE; SIRI; SII; Platelet-to-Lymphocyte Ratio; Monocyte-to-Lymphocyte Ratio; Systemic Immune-Inflammation Index; Systemic Inflammatory Response Index; Pan-Immune-Inflammation Value; 28-day Mortality
• Additional Relevant MeSH Terms: Crush Injuries; Musculoskeletal Diseases; Muscular Diseases; Wounds and Injuries; Pathologic Processes; Disease Attributes; Shock, Traumatic; Pathological Conditions, Signs and Symptoms; Critical Illness; Rhabdomyolysis; Crush Syndrome
• Other Study ID Numbers: B.30.2.ATA.0.01.00/756

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No