ALGORITHM FOR POST-BURN BACTERIAL SEPSIS DIAGNOSIS
DOI:
https://doi.org/10.14739/2310-1210.2013.5.18875Keywords:
sepsis, burns, diagnostic algorithm, procalcitoninAbstract
Introduction. In patients with extensive deep burns the most severe of all infectious and inflammatory complications is sepsis which causes high death rate.
The purpose of our work was to develop the algorithm of bacterial sepsis diagnosis in patients with severe burn disease.
Materials and methods. The study involved 140 burned patients divided into two groups: Group 1 – 78 patients who underwent necrectomy within 3-7 days after the burn, Group 2 (control) – 62 patients with necrectomy performed in later period. In 78 patients of the main group the average meaning of the total area of the burn was 45.47 ± 1.91% of the body surface (bs); of the deep burn area - 21.76 ± 1.85% bs, while in 62 patients of the control group it was respectively 40.03 ± 2.29% and 23.74 ± 1.81%.
Results of the research. In the main group, after early necrectomy, the number of symptoms of the systemic inflammatory response syndrome (SIRS) measured at an average from 1.79 to 2.03 of the 4 possible symptoms, which is 20-22% less compared to the control group of patients in whom surgical treatment was carried out at later terms. Death rate in patients with early necrectomy was 11.54 ± 3.62% (9 patients), while in the control group it was 32.26 ± 5.94% (20 patients). The causes of mortality were burn sepsis and pneumonia. In those patients who recovered the severity of SIRS was 1.4 times less in comparison with those who died. Out of 46 samples of blood serum procalcitonin (PCT), in 31 cases PCT level was <0.5 ng/ml, in 10 cases it ranged 0.5-2.0 ng/ml, and in 5 studies it was 2.0-10.0 ng/ml. Increased levels of PCT were found in burned patients with the developing sepsis. PCT level <0.5 ng/ml confirms the absence of bacterial sepsis, while the value of PCT grown to 0.5-2.0 ng/ml shows the necessity of dynamic monitoring of this index changes, and ≥2,0 ng/ml value of PCT confirms the presence of bacterial sepsis, which requires timely administration of adequate methods of treatment. While using SAPS modified prognostic scale (SAPS MPS) it was found out that in burned patients having the level of PCT >0.5 ng/ml, general condition severity measured >18 points.
Conclusions. Burn sepsis diagnosis algorithm incorporated SIRS level assessment, evaluation of the severity of patients’ condition using SAPS MPS (with SIRS >2 signs), determination of blood serum PCT level (with SAPS MPS ≥18 points). The use of this algorithm has allowed to significantly reduce the number of severe sepsis cases by 56 % and mortality rate by 64%.
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