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.