title: The Marmara earthquake: admission laboratory features of patients with nephrological problems.
abstract: BACKGROUND
  Earthquakes are major causes of morbidity and mortality. North-western Turkey was struck by a devastating earthquake in August 1999, which caused several thousand deaths. Among the most important morbid events in survivors were acute nephrological problems.
  
  
  METHODS
  Within the first week of the disaster, specific questionnaires asking about 63 clinical and laboratory parameters were sent to 35 reference hospitals that were treating the victims. Of the registered 639 victims, 423 were admitted within the first 3 days of the disaster; the admission laboratory data of these 423 patients are the subject of this analysis.
  
  
  RESULTS
  In the 423 patients (233 males, mean age 31.3+/-14.4 years), time under the rubble was 10.7+/-10.4 h. Mean values at admission were as follows: serum potassium 5.4+/-1.3 mEq/l, creatine phosphokinase 58205+/-77889 IU/l, albumin 2.6+/-0.7 g/dl, phosphorus 5.2+/-1.8 mg/dl, haematocrit 35.0+/-9.3%, leukocyte count 14945+/-6614/mm(3), platelet count 183975+/-134012/mm(3), blood urea nitrogen 55.1+/-28.9 mg/dl, and creatinine 3.9+/-2.3 mg/dl. Serum potassium above 6.5 mEq/l was noted in 91 patients (22.7%), an alarming finding for risk of fatal arrhythmias. Non-survivors were characterized by higher figures of serum potassium (P=0.001), as well as lower haematocrit (P=0.028), platelets (P<0.001), and serum albumin (P=0.003). In a multivariate analysis model of admission laboratory parameters, serum creatinine (P<0.001, o.r.=2.19), potassium (P=0.001, o.r.=3.64), and phosphorus (P=0.004, o.r.=1.78) predicted dialysis needs, whereas serum albumin (P=0.028, o.r.=0.23) and creatinine (P=0.039, o.r.=0.60) were related to mortality.
  
  
  CONCLUSIONS
  Admission laboratory data may be useful for predicting dialysis needs and survival chance of disaster victims. High incidences of some life-threatening abnormalities dictate the need for empirical therapy even in the field.
authors.affiliation: Department of Nephrology, Istanbul School of Medicine, Istanbul, Turkey. severm@hotmail.com
authors.forename: Mehmet Sükrü
authors.initials: MS
authors.lastname: Sever
authors.forename: Ekrem
authors.initials: E
authors.lastname: Erek
authors.forename: Raymond
authors.initials: R
authors.lastname: Vanholder
authors.forename: Cetin
authors.initials: C
authors.lastname: Ozener
authors.forename: Mahmut
authors.initials: M
authors.lastname: Yavuz
authors.forename: Hülya
authors.initials: H
authors.lastname: Ergin
authors.forename: Haluk
authors.initials: H
authors.lastname: Kiper
authors.forename: Didem
authors.initials: D
authors.lastname: Korular
authors.forename: Başol
authors.initials: B
authors.lastname: Canbakan
authors.forename: Turgay
authors.initials: T
authors.lastname: Arinsoy
authors.forename: Wim
authors.initials: W
authors.lastname: VanBiesen
authors.forename: Norbert
authors.initials: N
authors.lastname: Lameire
mesh_terms: D058186:Acute Kidney Injury / Q000097:blood / Q000145:classification / Q000453:epidemiology* / Q000209:etiology; D001774:Blood Chemical Analysis; D004190:Disasters; D006400:Hematocrit; D006801:Humans; D007674:Kidney Diseases / Q000097:blood / Q000145:classification / Q000453:epidemiology* / Q000209:etiology; D007958:Leukocyte Count; D010976:Platelet Count; D012044:Regression Analysis; D011795:Surveys and Questionnaires; D014421:Turkey / Q000453:epidemiology