Validating the utilisation of venous bicarbonate as a predictor of acute kidney injury in crush syndrome from sjambok injuries

• Published in: South African medical journal 2017-05, Vol.107 (5), p.446-450
• Main Authors: Skinner, David Lee, Laing, Grant L, Bruce, John, Biccard, Bruce, Muckart, David J J
• Format: Article
• Language: English
• Subjects: Acute kidney injury; Crush syndrome; Renal failure; Surgery; Trauma
• ISSN: 0256-9574; 2078-5135
• DOI: 10.7196/SAMJ.2017.v107i5.12213

Crush injury secondary to sjambok beatings is a well-described phenomenon in southern Africa. Owing to a number of factors, it can result in acute kidney injury (AKI). In 1992, Muckart et al. described a risk stratification system using venous bicarbonate (VB) that can be used in the management of these patients. To validate this score in the modern era of AKI risk stratification. A retrospective study was performed on a local trauma database from June 2010 to December 2012. All patients with crush injury from sjambok/blunt instrument beatings were included in the analysis. VB was compared with the Kidney Disease Improving Global Outcomes scoring system for AKI. Serum base excess (BE) and creatine kinase were also examined as biomarkers. The endpoints were the need for renal replacement therapy (RRT) and mortality. Three hundred and ten patients were included. The overall mortality rate was 1.9%, 14.8% of patients had AKI, and 3.9% required RRT. Both VB and BE performed well in RRT prediction, with areas under the receiver operating characteristic curve of 0.847 (95% confidence interval (CI) 0.756 - 0.938; p