Abstract Background Crush syndrome is a life-threatening consequence of prolonged muscle compression, and acute kidney injury (AKI) is a major determinant of morbidity and mortality. Rapid AKI risk stratification at emergency department (ED) presentation remains challenging. We evaluated whether the lactate dehydrogenase-to-albumin ratio (LDAR) measured at ED admission could discriminate creatinine-defined AKI among patients with crush syndrome. Methods We conducted a retrospective cohort study in the ED of a Level I trauma center from 1 January 2019 to 31 December 2025. Adults (≥ 18 years) meeting a predefined operational definition of crush syndrome, including traumatic compression injury, biochemical rhabdomyolysis, and compatible clinical or systemic features, were included. AKI was defined using serum creatinine-based Kidney Disease: Improving Global Outcomes criteria with a predefined approach for baseline creatinine determination. LDAR was calculated as admission lactate dehydrogenase divided by admission albumin. Discrimination was assessed using receiver operating characteristic (ROC) analysis with area under the curve (AUC) and 95% confidence intervals. Independent associations with AKI and RRT were examined using multivariable logistic regression. Results Among 512 patients, 180 (35.2%) were classified as having creatinine-defined AKI; 374 (73.0%) were male. Hemodialysis was required in 78/180 (43.3%) patients with AKI, and in-hospital mortality was higher in patients with AKI (15.0% vs. 0.6%). Creatine kinase (CK) showed the highest discrimination for AKI (AUC 0.977, 95% CI 0.964–0.989), followed by LDAR (AUC 0.966, 95% CI 0.953–0.980). A Youden-derived LDAR cut-off of ≥ 23.59 yielded 86.7% sensitivity and 96.7% specificity. In addition, an LDAR cut-off of ≥ 22.68 predicted RRT requirement in patients with CS with 97.4% sensitivity and 77.6% specificity. Conclusions LDAR measured at ED presentation showed high discrimination for AKI and RRT in crush syndrome. Although not a stand-alone treatment trigger, it may support early renal risk stratification when interpreted together with CK, renal function, electrolyte status, and clinical severity. Clinical trial number Not applicable.
Gur et al. (Sat,) studied this question.