Factors of Non-specific Resistance of the Organism in Patients with Purulent Necrotic Processes of Diabetic Foot and in the Development of Sepsis
Literature data indicate that 30–70 % of patients with diabetes mellitus have purulent necrotic processes affecting all the tissues of the foot. In case of sepsis, mortality in these patients reaches 28–33 %. The objective of our study was to evaluate the non-specific resistance factors in patients with purulent necrotic processes of diabetic foot and in the development of sepsis. Material and methods. There were analyzed the results of treatment of 427 patients with purulent necrotic processes of diabetic foot, in 6.8 % of the cases (29 patients) the disease was complicated by sepsis. The most common cause of sepsis was wet gangrene of the lower extremities, it has been detected in 89.7 % of cases (26 subjects). Severe sepsis with multiple organ failure events was observed in 72.4 % of cases (21 patients). Results and discussion. In order to assess non-specific immunity, we have studied phagocytic activity of neutrophils (HCT-test, phagocytic number), complement activity. Investigations were carried out before and after (7–8th and 12–16th days) surgery. Depending on the data received prior to treatment, all patients were divided into 3 groups: with a uniformly activated, suppressive and mixed type of immune status. In the process of observation, we have found that in group 1 patients, reduction in complement activity at admission changed to significant (P < 0.05) increase on 7–8th and 12–16th days. Content of HCT-positive cells in patients with diabetic foot syndrome and sepsis was 1.75 and 1.6 times higher than the control values. Phagocytic number did not differ from the control values. In group 2 patients with complicated diabetic foot syndrome, at admission the complement activity of blood serum was 10 % lower than normal one and increased to 12–16th days, and in patients with sepsis, this indicator had a peak decline to 12–16th days (P < 0.05). An increased number of HCT-cells was determined in both diabetic foot syndrome and sepsis. Phagocytic number of septic patients was reduced (P < 0.05), whereas in patients with complicated diabetic foot syndrome did not differ from the control values (P > 0.05). In group 3 patients with complicated diabetic foot syndrome, phagocytic number tended to increase at 7–8th and 12–16th days, whereas in patients with sepsis, this figure was reduced. Complement level exceeded the control values (P < 0.05) in patients with complicated diabetic foot syndrome, we could not follow the dynamics of this indicator in patients with sepsis because of the deaths in the early postoperative period. Conclusions. The factors of non-specific resistance considered in the dynamics can be used as a predictor of the disease course and outcome in patients with complicated diabetic foot syndrome and sepsis.
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