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Severity of sepsis and congestive heart failure in Type 2 diabetic patients undergoing surgery for gangrene, abscess, or cellulitis

Session Poster session 1 Saturday 08:30 -17:30

Speaker Evgeniya Shalaeva

Congress : Heart Failure 2015

  • Topic : heart failure
  • Sub-topic : Chronic Heart Failure
  • Session type : Poster Session
  • FP Number : P250

Authors : E Shalaeva (Tashkent,UZ), B Babadjanov (Tashkent,UZ), A Bobabekov (Tashkent,UZ), U Pulatov (Tashkent,UZ), A Shalaeva (Tashkent,UZ), N Dadabaeva (Tashkent,UZ), M Babadjanova (Tashkent,UZ)

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Authors:
E Shalaeva1 , B Babadjanov1 , A Bobabekov1 , U Pulatov1 , A Shalaeva2 , N Dadabaeva2 , M Babadjanova2 , 1Tashkent Medical Academy, Republican Centre of purulent surgery and complications of diabetes - Tashkent - Uzbekistan , 2Tashkent Medical Academy - Tashkent - Uzbekistan ,

Citation:
European Journal of Heart Failure Abstracts Supplement ( 2015 ) 17 ( Supplement 1 ), 52

The aim of the study was evaluate interconnection between severity of sepsis and congestive heart failure in Type 2 diabetic patients undergoing surgery for purulent-necrotic complications.

Methods: We analyzed 320 symptomatic consecutive Type 2 Diabetic patients (142 women and 178 men) aged 57,8 ± 8,2 years undergoing surgery for gangrene, cellulitis, or abscess. Patients were divided into 4 groups: without sepsis 91(28.4%), with sepsis 112(35.0%), severe sepsis 79(27.7%), and septic shock in 38(11.9%). All the patients underwent laboratory tests, ECG, echocardiography.

Results: Among purulent complications prevailed gangrene of lower extremities 171 (53.4%). Partial foot amputation was in 74 (43.3%) cases, ankle disarticulation in 44 (25.7%), below-knee amputation was in 29 (17%), above-knee amputation (transfemoral) in 24 (14%). Abscess or cellulitis of lower limb was in 81 (25.3%) and 68 (21.3%), respectively. We diagnosed coronary heart disease functional class III in all selected patients, congestive heart failure functional class II (NYHA) was in 52 (16.3%), III in 190 (59.4%) and IV in 78 (24.4%) patients, left ventricle ejection fraction (LVEF)>55% in 121(45.5%), 55-30% in 145(54.5%). In severe sepsis and septic shock, we found a significant decrease in blood pressure and LVEF (p < 0.001) (Table).Blood coagulation and renal function worsen significantly with increasing severity of septis. BNU was significantly higher in septic patients then without it (p < 0.001)

Conclusion: With an increase the severity of septic complications in Type 2 diabetic patients undergoing surgery for purulent-necrotic complications, increased functional class of congestive heart failure (NYHA), decreased LVEF, and increased BNP.

Data No sepsis Sepsis Severe sepsis Septic shock P-value
Systolic blood pressure 158.7±14.4 154.1±22.8 88.7±9.4* 64.1±7.8* ≤0.001
Diastolic blood pressure 93.4±5.3 91.9±8.6 63.4±5.3* 31.9±7.6* ≤0.001
LVEF, % 54.3±3.3 48.7±4.1 43.3±4.4 38.3±3.1* ≤0.001
HbA1C, % 9.1±1.1 13.9±0.5* 14.4±2.5* 13.9±0.9* ≤0.001
Fibrinogen, mg% 511±152 722±132 754±127 995±165* ≤0.001
Blood urea, mmol/l 7.1±1.9 12.4±1.6 12.1±2.2 16.8±2.7* ≤0.001
Blood creatinine, mmol/l 88±18 123±27* 167±17* 163±47 ≤0.001
Brain natriuretic peptide, ng/ml 232±28 395±35* 412±32* 445±41 ≤0.001
* - comparison with group without sepsis

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