Abstract
Objective: to study the time course of immunological changes in patients with acute severe brain injury (SBI) and their use along with the integrated indices of evaluation of its severity to define criteria for predicting the development of pyoseptic complications. Subjects and methods. Immunological parameters were studied in 53 SBI patients aged 17—65 years on days 1, 7, and 14 days after injury. There were 2 groups: 1) 16 patients without complications; 2) 37 patients with pyoseptic complications in the acute period of the disease. The integral scales SIRS, CPIS, Glasgow coma scale (GCS), APACHE II, laboratory parameters (immunograms, platelets, soluble fibrin-monomer complexes, and medium molecular weight peptides) in the prediction of pyoseptic complications were analyzed in patients with SBI. A control group consisted of 23 apparently healthy individuals. Results. The found immunological parameters lead to the conclusion that patients with SBI had significant immunodeficiency of mixed genesis by the cellular and humoral types in the acute period of the disease, immune system activation at week 2 of the disease in the development of pyoseptic complications. The decrease in the immunoregulatory index or less than 1.17 or its increase or more than 2.55 on day 1 after SBI was associated with the higher risk of pyoseptic complications. Some indices of an immunogram and the integral scales APACHE II, SIRS, CPIS, and GCS were found to be of low importance in the prediction of pyoseptic complications in SBI. Multivariate regression analysis showed that indices, such as the relative blood count of CD3+, CD95+ lymphocytes, platelets, the serum levels of immunoglobulin M and medium molecular weight peptides (at 262 nm), as well as GCS scores and the maximum temperature on the day of the investigation, were of the greatest value in the construction of prognostic models. Conclusion. The proposed models for the prediction of pyoseptic complications in the acute period of SBI may be useful in optimizing the use of antibiotics and immunomodulating therapy. Key words: severe brain injury, prediction of pyoseptic complications, cellular and humoral immunological parameters.
Highlights
Immune Status in the Acute Period of Severe Brain Injury in the Development of Pyoseptic Complications
Immunological parameters were studied in 53 SBI patients aged 17—65 years on days 1, 7, and 14 days after injury
The integral scales SIRS, CPIS, Glasgow coma scale (GCS), APACHE II, laboratory parameters in the prediction of pyoseptic complications were analyzed in patients with SBI
Summary
Обследовано 53 больных с ТЧМТ, в возрасте от 17 до 65 лет (38,2±12,3 лет). Мужчин было 48 (90,5%), женщин — 5 (9,4%). Тяжесть травмы оценивали в соответствии с «Классифи кацией черепно мозговой травмы», для оценки степени нару шения сознания использовали шкалу ком Глазго (ШКГ) [8], тяжести состояния — шкалу APACHE II [9]. 2 я группа — 37 больных, у которых в послеоперационном периоде формировались гнойно септические осложнения. Ды, растворимые фибрин мономерные комплексы и др.) [4] в прогнозировании гнойно септических осложнений у больных с ТЧМТ. Всем больным назна чались антибактериальные препараты — цефалоспорины II III поколения в сочетании с аминогликозидами, а при развитии гнойно септических осложнений проводилась коррекция ан тибактериальной терапии в соответствии с чувствительностью высеваемой микрофлоры к антибиотикам. Критерием исключения из исследования было наличие у больных массивных аспираций, сахарного диабета, декомпен сированных заболеваний сердца, онкологических заболева ний, а так же применение в комплексной терапии ТЧМТ глю кокортикостероидов. Полученные данные обрабатывали используя возможнос ти программы «Statistica 7» (критерии Стьюдента, χ2, корреля ционный и многофакторный регрессионный анализ)
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