Anemia in patients with necrotizing soft tissue infections, pathogenetic and prognostic value

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Abstract

BACKGROUND: Necrotizing soft tissue infection is one of the most severe life-threatening surgical infections with a very high mortality rate. A characteristic feature of necrotizing soft tissue infection is the rapid development of anemia, the causes and prognostic value of which are not well understood.

AIM: The purpose of this study was to investigate the timing, development, and dynamics of anemia in generalized forms of necrotizing infection to identify clinical and bacteriological factors associated with its development.

MATERIALS AND METHODS: 129 patients with necrotizing soft tissue infection who were treated from 09.2015 to 12.2019 in the department of purulent-septic surgery at Hospital of the Holy Great Martyr George were examined. All patients received surgical treatment, laboratory hematological, biochemical examination, bacteriological examination of blood, and wound discharge. Overall, 22 patients suffered from systemic inflammatory response syndrome, 63 patients with sepsis, and 41 patients with septic shock.

RESULTS: The Counts of hemoglobin and red blood cells in necrotizing soft tissue infection patients with sepsis revealed the anemia already during the first day and then from the 15th day of the disease, the red blood cell values began to rise in the patients who survived. However, continued to decrease in the deceased patients. In the group of deceased sepsis patients from day 3 of hospitalization, correlations between red blood cells count and potassium ion concentration (r = –0.318; p < 0.01), and red blood cells count and total plasma protein (r = 0.30; p < 0.01) became significant. Among patients with hemoglobin <110 g/L on the day of hospitalization, 36 of 67 (53.7%) patients died, and among those with hemoglobin levels >110 g/L, 20 of 62 (32.2%) patients died (p = 0.004). The highest lethality was registered patients who suffered from wound discharge Klebsiella pneumoniae (12 of 18, 66.7%) or anaerobic infection, but marked anemia was noted only in patients with anaerobic infection (Proteus spp., Clostridium spp., Bacteroide spp.) (8 out of 12, 66.7%).

CONCLUSIONS: We attribute the development of anemia in sepsis patients to the destruction of red blood cells. The type of infectious agent influences both the mortality rate and the degree of anemia, which is probably related to the ability of bacteria to destroy red blood cells.

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About the authors

Natalia B. Serebryanaya

Institute for Experimental Medicine; North-Western State Medical University named after I.I. Mechnikov

Author for correspondence.
Email: serebr@gmail.com
ORCID iD: 0000-0002-2418-9368
SPIN-code: 2240-1277
Scopus Author ID: 6701636993
ResearcherId: G-1663-2015

MD, Dr. Sci. (Med.), Professor, Head of the Laboratory of General Immunology, Department of Immunology, Senior Research Associate of the Department of General Pathology and Pathophysiology; Professor of the Department of Clinical Mycology, Allergology and Immunology

Russian Federation, Saint Petersburg; Saint Petersburg

Ivan V. Avdoshin

City Hospital of the Holy Great Martyr George

Email: ivan_avdoshin@mail.ru
ORCID iD: 0000-0003-2244-0771

Surgeon, Department of Surgical Infection and Sepsis

Russian Federation, Saint Petersburg

Oleg B. Chernyshev

City Hospital of the Holy Great Martyr George

Email: holger_tch@mail.ru
ORCID iD: 0000-0002-4874-9964

MD, Cand. Sci. (Med.), Surgeon, Department of Surgical Infection and Sepsis

Russian Federation, Saint Petersburg

Mikhail A. Shatil

City Hospital of the Holy Great Martyr George

Email: shatil57@mail.ru
ORCID iD: 0000-0002-8946-3495
ResearcherId: P-6005-2015

Chief Surgeon, Department of Surgical Infection and Sepsis

Russian Federation, Saint Petersburg

Natalia A. Bubnova

Academician I.P. Pavlov First St. Petersburg State Medical University

Email: bubnova44@list.ru
ORCID iD: 0000-0002-2128-3316
ResearcherId: H-2319-2015

MD, Dr. Sci. (Med.), Professor, Department of General Surgery

Russian Federation, Saint Petersburg

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2. Fig. 1. Dynamics of the concentration of hemoglobin (а) and the blood cells number (b) in patients with septic shock (n = 44), sepsis (n = 63), and systemic inflammatory response syndrome (SIRS) (n = 22). * p ≤ 0.05; ** p ≤ 0.01; *** p ≤ 0.001; # p ≤ 0.05 in median test (Bonferroni post-hoc)

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3. Fig. 2. Dynamics of hemoglobin levels (a) and red blood cells number (b) in the groups of surviving and dead patients with necrotizing soft tissue infection. * p ≤ 0.05; ** p ≤ 0.01; *** p ≤ 0.001

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4. Fig. 3. Correlation of red blood cells number and the concentration of potassium in serum on day 3 in dead patients with necrotizing soft tissue infection (r = –0.318; n = 40; p < 0.01)

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5. Fig. 4. Relationship between the red blood cells number and the total protein concentration in the blood plasma of dead patients with necrotizing soft tissue infection on day 3 (r = 0.30; n = 40; p < 0.01)

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6. Fig. 5. Dynamics of the hemoglobin concentration (a) and the red blood cells number (b) in patients with necrotizing soft tissue infection, depending on the type of bacteria in the wound discharge. * p ≤ 0.05; ** p ≤ 0.01; *** p ≤ 0.001. Anaerobes — Proteus mirabilis, Proteus vulgaris, Clostridium perfringens, Bacteroides fragilis. Cocci — Staphylococcus aureus, Streptococcus pyogenes, Streptococcus viridans, Streptococcus agalactia, Streptococcus dysgalactiae, Enterococcus faecalis, Enterococcus faecium

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