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Volume 18 Supplement 2

Sepsis 2014

  • Poster presentation
  • Open Access

Impact of purulent complications and sepsis on cardiovascular system in patients with type 2 diabetes

  • E Shalaeva1,
  • B Babadjanov1,
  • U Pulatov1,
  • N Dadabayeva1 and
  • A Shalaeva1
Critical Care201418(Suppl 2):P6

https://doi.org/10.1186/cc14009

Published: 3 December 2014

Keywords

Congestive Heart FailureAcute Myocardial InfarctionArterial HypertensionBrain Natriuretic PeptideSeptic Complication

Introduction

Purulent complications in patients with type 2 diabetes are usually severe, often complicated by sepsis and require emergency surgery. Noncardiac surgery is associated with a 7 to 11% complication rate and mortality of 0.8 to 1.5% [1], up to 42% are cardiac reasons [2]. After surgery, 2% of patients suffer major cardiac complications [3], and 8% show evidence of significant myocardial injury [2]. The aim of this study was to identify the impact of purulent complications and sepsis on cardiovascular system in patients with type 2 diabetes.

Methods

We analyzed 112 consecutive patients (54 men and 58 women) aged 57.2 ± 8.4 years with purulent-necrotic complications (gangrene, phlegmon, and abscess) of type 2 diabetes and sepsis in 2013. We compared laboratory and instrumental data (blood tests, ECG, echocardiography and others), which were previously obtained in the same patients receiving inpatient treatment before sepsis (2011 to 2012).

Results

Gangrene of lower extremities in 59 (52.7%) prevailed among purulent complications. After the development of sepsis we detected in all patients significantly increased heart rate, respiratory rate per minute, leukocytosis, anemia, worse glucose metabolism and renal function (Table 1). Congestive heart failure became more severe. This was confirmed by decrease of left ventricle ejection fraction (55.2 ± 5.1% before sepsis vs. 49.3 ± 4.1% after) and increase brain natriuretic peptide (291.4 ± 34.5 ng/ml vs. 395.2 ± 28.1 ng/ml, P < 0.001). Prior sepsis in 66 (58.9%) of patients with arterial hypertension was observed, after in 88 (78.6%). After admission to the centre, patients had no signs of septic shock. In 13 (11.6%) patients, the perioperative period was complicated by acute myocardial infarction, which was accompanied by a fall in blood pressure. We detected an increase of the functional class of stable angina, congestive heart failure, 4.2 times increased incidence of unstable angina, 2.6 times ventricular and four times supraventricular extra systole after septic complications (Table 2).
Table 1

Hemodynamic parameters and blood tests in patients with purulent complications of type 2 diabetes and sepsis

Parameter

Before sepsis (n= 112)

After sepsis (n= 112)

P value

Heart rate (beats/minute)

78.4 ± 15.2

112.5 ± 18.9

< 0.001

Respiratory rate (breaths/minute)

18.0 ± 2.0

29.5 ± 5.5

< 0.001

Systolic BP (mmHg)

155.7 ± 35.4

154.2 ± 58.5

n.s.

Diastolic BP (mmHg)

90.4 ± 10.3

91.9 ± 8.6

n.s.

Left ventricle ejection fraction (%)

55.2 ± 5.1

49.3 ± 4.1

0.033

Fasting plasma glucose (mmol/l)

8.4 ± 2.5

15.4 ± 4.8

< 0.001

Two-hour plasma glucose (mmol/l)

10.2 ± 2,8

19.9 ± 3.3

< 0.001

HbA1c (%)

8.4 ± 0.5

12.1 ± 0.5

< 0.001

Hemoglobin (g/l)

121.5 ± 12.5

105.4 ± 11.7

0.04

White count (103)

6.7 ± 1.2

14.4 ± 2.1

< 0.001

Fibrinogen (mg%)

411.6 ± 103.6

715.4 ± 215.5

< 0.001

Blood urea (mmol/l)

6.1 ± 2.9

8.8 ± 2.5

0.011

Blood creatinine (mmol/l)

88.4 ± 18.5

105.6 ± 17.3

0.02

Brain natriuretic peptide (ng/ml)

291.4 ± 34.5

395.2 ± 28.1

< 0.001

BP, blood pressure; HbA1c, glycosylated hemoglobin A1c.

Table 2

Cardiovascular comorbidity in patients with type 2 diabetes before and after purulent-necrotic complications and sepsis

Parameter

Before sepsis (n= 112)

After sepsis (n= 112)

Insulin dependence

42 (37.5)

112 (100)

Normal blood pressure (110 to 139 mmHg)

46 (41.1)

11 (9.8)

Arterial hypertension

66 (58.9)

88 (78.6)

First degree (140 to 159 mmHg)

33 (29.5)

21 (8.9)

Second degree (160 to 179 mmHg)

21 (18.6)

43 (38.4)

Third degree (>180 mmHg)

12 (10.7)

24 (21.4)

Arterial hypotension (<90 mmHg)

-

13 (11.6)

CAD, stable angina

108 (94.6)

82 (73.2)

FC I

18 (16.1)

-

FC II

29 (25.9)

18 (16.1)

FC III

52 (46.4)

45 (40.2)

FC IV

9 (8.0)

19 (17.0)

CAD, unstable angina

4 (3.6)

17 (15.2)

Acute myocardial infarction

-

13 (11.6)

Postinfarction cardiosclerosis

7 (6.3)

7 (6.3)

Atrial fibrillation

7 (6.3)

7 (6.3)

Supraventricular arrhythmia

3 (2.7)

12 (10.7)

Ventricular arrhythmia

14 (12.5)

36 (32.1)

Congestive heart failure

112 (100)

112 (100)

FC II (NYHA)

76 (67.8)

26 (23.2)

FC III (NYHA)

36 (32.1)

65 (58)

FC IV (NYHA)

-

21 (18.7)

Abscesses of the lower extremity

-

22 (19.6)

Phlegmon of the lower extremity

-

31 (27.7)

Gangrene of lower extremity

-

59 (52.7)

Data presented as n (%). CAD, coronary artery disease; FC, functional class; NYHA, New York Heart Association.

Conclusion

After the development of purulent complications and sepsis in patients with type 2 diabetes, we observed increased incidence of arterial hypertension, arrhythmias, worsened severity of coronary artery disease and congestive heart failure. Perioperative risk of acute myocardial infarction amounted to 11.6%.

Authors’ Affiliations

(1)
Republican Center of Purulent Surgery and Complications of Diabetes, Tashkent Medical Academy, Tashkent, Uzbekistan

References

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Copyright

© Shalaeva et al.; licensee BioMed Central Ltd. 2014

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

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