Pathogenetic and Prognostic Significance of Thrombocytopenia in Patients With Necrotizing Soft Tissue Infections

N B Serebryanaya,O B Chernyshev,N A Bubnova,I V Avdoshin,M A Shatil

doi:10.15360/1813-9779-2021-1-34-45

N B Serebryanaya, O B Chernyshev + Show 3 more

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https://doi.org/10.15360/1813-9779-2021-1-34-45

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Journal: General Reanimatology	Publication Date: Feb 25, 2021
Citations: 1	License type: cc-by

Abstract

Necrotizing soft tissue infection (NSTI) is a severe surgical infection which can result in sepsis and septic shock when generalized.The aim of the study was to determine the frequency of thrombocytopenia in patients with generalized NSTI, the factors promoting its development, and its association with septic shock.Materials and Methods. We examined 129 patients with NSTI treated between 09.2015 and 12.2019 at St. George Hospital in St. Petersburg, Russia. Surgical treatment, hematological and biochemical examinations, and bacteriological analysis of blood and wound discharge were performed in each patient. The studied group included 22 patients with systemic inflammatory reaction syndrome, 63 patients with sepsis, and 44 patients with septic shock.Results. We found a decrease in platelet count in NSTI patients with septic shock as early as on the first day of the disease and its further decrease within the next 3 days, with the mean platelet volume (MPV) increasing during the same period and significantly exceeding that in patients with sepsis and systemic inflammatory response syndrome. In NSTI patients with thrombocytopenia on admission, we found a significant correlation between the platelet count and the percentage of segmented neutrophils (r=0.349; P<0.001; n=40). The maximum incidenсe of septic shock was observed in patients infected with Klebsiella pneumoniae (13 out of 19, 65%). These patients had the highest MPV but did not develop thrombocytopenia. Maximum frequency of thrombocytopenia and elevation of MPV and platelet distribution width (PDW) was found in patients with NSTI and underlying chronic viral hepatitis C. However, the relative frequency of septic shock in these patients was not increased.Conclusion. The development of septic shock in NSTI is associated with a specific platelet activation pattern

Highlights

Некротизирующая инфекция мягких тканей (НИМТ) — одна из самых тяжелых форм хирургических инфекций, которая характеризуется быстро прогрессирующим некрозом фасции, подкожной клетчатки и мышц [1]
Our findings indicate that patients who developed septic shock (SS) were on average older, sought specialized surgical care earlier due to a more acute onset, had a larger wound area and more severe multiple organ failure than patients with sepsis
Platelet activation and thrombocytopenia in generalized Necrotizing soft tissue infection (NSTI) are important factors of septic shock development, which increases the risk of death

Summary

Introduction

Некротизирующая инфекция мягких тканей (НИМТ) — одна из самых тяжелых форм хирургических инфекций, которая характеризуется быстро прогрессирующим некрозом фасции, подкожной клетчатки и мышц [1]. В последние годы в развитых странах наблюдается существенный рост частоты ее развития [2]. Наиболее частыми возбудителями мономикробной инфекции являются β-гемолитические стрептококки и метициллин-резистентные золотистые стафилококки [3]. При полимикробных формах выявляется кокковая флора и грамотрицательные энтеробактерии, в том числе эндогенные [4]. НИМТ часто протекает на фоне тяжелых соматических заболеваний, что существенно влияет на исход заболевания. Показатели летальности и частоты развития сепсиса при НИМТ колеблются от 20 до 80–100%, составляя в некоторых группах больных 62,5–77,6% случаев [2, 5, 6]

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