EARLY DIFFERENTIAL DIAGNOSIS PRINCIPLES OF LOCAL AND GENERALIZED FORMS OF SURGICAL SOFT TISSUE INFECTION

Abstract

Aim. To determine the occurrence rate and to search the methods of early clinicolaboratory diagnosis of different variants of generalized form of surgical soft tissue infection. Materials and methods. Prospective study of the results of treatment of 2350 patients with different purolo-necrotic diseases of the soft tissues was carried out. Results. The results of dynamic blood TNF, IL-1RA, CRP, oligopeptides and lactoferrin investigation in local and generalized forms of soft tissue infection detected direct correlation between CRP, oligopeptide, lactoferrin and TNF levels that allowed to use these markers in diagnosis of generalized forms of infection. Taking into account the results of analysis, diagnostic criteria of compensated systemic inflammatory response syndrome and sepsis were determined. Sepsis is characterized by increase in CRP>30 mg/l, oligopeptides>0,34 un, lactoferrin>1900 ng/ml, TNF>6 pg/ml and decrease in IL-1RA<1500 pg/ml with systemic inflammatory response syndrome preserved for more than 72 hours from the initiation of an adequate therapy. Lower blood TNF, CRP, oligopeptide and lactoferrin concentrations and IL-1RA level exceeding 1500 pg/ml accompany the compensated systemic inflammatory response syndrome. Conclusion. A new approach used for early diagnosis of generalized infection makes it possible to optimize and raise the efficiency of its treatment.