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Volume 18 Supplement 2

Sepsis 2014

  • Poster presentation
  • Open Access

Severity of sepsis in patients with acute purulent destructive pulmonary disease depending on the presence of type 2 diabetes: impact on the forecast

  • A Babobekov1,
  • B Babadjanov1,
  • S Atakov1 and
  • E Shalaeva1
Critical Care201418(Suppl 2):P7

https://doi.org/10.1186/cc14010

Published: 3 December 2014

Keywords

Septic ShockLung DiseaseSevere SepsisMultiple Organ FailureNormal Glucose

Introduction

Lung abscesses and gangrene are the most severe clinical manifestation and outcome among acute purulent destructive pulmonary disease (APDPD). Mortality ranges from 10 to 35%, and in the presence of diabetes increases up to 30 to 90% [1]. The main reason for this is the generalization of infection (sepsis), leading to the development of multiple organ failure [2, 3]. The aim of this study was to identify the severity of sepsis in patients with APDPD depending on the presence of type 2 diabetes, and the impact on the forecast.

Methods

During the period 2012 to 2013, we examined 408 patients aged 48.5 ± 12.5 years (258 men/150 women) who underwent surgical treatment for APDPD. The patients were divided into two groups: 144 patients with type 2 diabetes, and controls (n = 246). We carried out computed tomography, ECG, echocardiography, laboratory biochemical testing, and bacteriological analysis of pathologic material and blood samples.

Results

Patients with type 2 diabetes had much more complications and cases of severe sepsis and septic shock (Table 1). Bacteriological analysis of the pathologic material showed Gram-positive bacteria in 35 to 45%, anaerobic association in 55 to 65%, pathological fungi in 50 to 60%. The patients with type 2 diabetes had much more time from the onset of the first symptoms of lung disease prior to admission (12.5 ± 3.5 vs. 7.5 ± 2.5 days, P = 0.002), and the duration of inpatient treatment was significantly longer (13.8 ± 5.5 vs. 7.1 ± 3.4 days, P = 0.001). Only 53 (36.8%) of patients with type 2 diabetes and 68 (29.5%) without it had bacteriological positive blood culture. The analysis of the distribution of pathogens in groups is presented in Figure 1. Patients with diabetes had more Candida spp. (Figure 1). Figures 2, Figure 3 and Figure 4 present the X-ray dynamics of a 42-year-old man with lung abscess. Clinical recovery in patients with type 2 diabetes was significantly worthy compared to controls (45 (31.2%) vs. 153 (57.9%)), mortality rate 48 (33.3%) versus 39 (14.7%), respectively.
Table 1

Clinical symptoms and severity of sepsis in patients with acute purulent destructive pulmonary disease depending on the presence of type 2 diabetes

Data

Type 2 diabetes (n= 144)

Control (n= 264)

Acute lung abscess

59 (40.9)

122 (46.2)

Necrotizing pneumonia

47 (32.6)

98 (37.1)

Lung gangrene

38 (26.4)

44 (16.7)

Empyema

88 (61.1)

81 (30.7)

Pyopneumothorax

16 (11.1)

9 (3.4)

Mediastinitis

34 (23.6)

16 (6.1)

Body temperature >38°C/<36°C

98 (68.1)/21 (14.6)

261 (98.9)/3 (1.1)

Respiratory rate >20/minute

144 (100)

264 (100)

Heart rate >90 beats/minute

138 (95.8)

242 (91.7)

PaCO2 <32 mmHg

144 (100)

264 (100)

Leukocytes >12,000/<4,000 cells/mm3

111 (77.1)/13 (9.1)

202 (76.5)/11 (4.2)

Renal failure, oliguria

42 (29.2)

34 (12.9)

Increase liver enzymes

34 (23.6)

45 (17.1)

Systolic blood pressure <90 mmHg

33 (22.9)

51 (19.3)

Sepsis

101 (70.1)

223 (84.5)

Severe sepsis

25 (17.4)

29 (11.0)

Septic shock

18 (12.5)

12 (4.5)

Data presented as n (%).

Figure 1

Figure 1

Figure 2
Figure 2

Man, 42 years old, with right lung abscess after admission to the centre

Figure 3
Figure 3

The same patient on the fourth day after drainage of the abscess

Figure 4
Figure 4

The same patient before discharge, 14 days in dynamics.

Conclusion

In patients with acute purulent destructive pulmonary disease and type 2 diabetes, severe sepsis and septic shock more often prevailed, inpatient mortality rate was 2.27 times higher, compared to patients with normal glucose metabolism.

Authors’ Affiliations

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

References

  1. Defraigne JO, et al.: Cavernostomy: an old but effective technique in the treatment of pulmonary abscess. Rev Med Liege 2007, 52: 498-501.Google Scholar
  2. Refaely J, Weissberg D: Gangrene of the lung: treatment in two stages. Ann Thorac Surg 1997, 64: 970-973. 10.1016/S0003-4975(97)00837-0View ArticlePubMedGoogle Scholar
  3. Rice TW, Ginsberg PJ, Todd TR: Tube drainage of lung abscesses. Ann Thorac Surg 1987, 44: 356-359. 10.1016/S0003-4975(10)63790-3View ArticlePubMedGoogle Scholar

Copyright

© Babobekov 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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