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Necrotizing soft tissue infection (NSTI) is a severe surgical infection which can result in sepsis and septic shock when generalized.The aim of the study was to determine the frequency of thrombocytopenia in patients with generalized NSTI, the factors promoting its development, and its association with septic shock.Materials and Methods. We examined 129 patients with NSTI treated between 09.2015 and 12.2019 at St. George Hospital in St. Petersburg, Russia. Surgical treatment, hematological and biochemical examinations, and bacteriological analysis of blood and wound discharge were performed in each patient. The studied group included 22 patients with systemic inflammatory reaction syndrome, 63 patients with sepsis, and 44 patients with septic shock.Results. We found a decrease in platelet count in NSTI patients with septic shock as early as on the first day of the disease and its further decrease within the next 3 days, with the mean platelet volume (MPV) increasing during the same period and significantly exceeding that in patients with sepsis and systemic inflammatory response syndrome. In NSTI patients with thrombocytopenia on admission, we found a significant correlation between the platelet count and the percentage of segmented neutrophils (r=0.349; P<0.001; n=40). The maximum incidenсe of septic shock was observed in patients infected with Klebsiella pneumoniae (13 out of 19, 65%). These patients had the highest MPV but did not develop thrombocytopenia. Maximum frequency of thrombocytopenia and elevation of MPV and platelet distribution width (PDW) was found in patients with NSTI and underlying chronic viral hepatitis C. However, the relative frequency of septic shock in these patients was not increased.Conclusion. The development of septic shock in NSTI is associated with a specific platelet activation pattern

The aim of our study was to assess of microcirculation using laser Doppler flowmetry (LDF) in patients with diabetic foot syndrome (DFS) caused by diabetes mellitus type 2. Materials and methods. The main group consisted of 16 patients with DFS. In the control group, 19 patients without diabetes mellitus were included. An LDF investigation was performed using Biopac LDF 100C system. Estimated glomerular filtration rate (eGFR) was determined using CKD-EPI formula. Results and discussion. According to LDF, patients with DFS had the severe form of microcirculatory failure, with abrupt worsening of venous drainage, caused by venous lesion during the diabetic microangiopathy. The marker LDF phenomena were decreasing of flaxmotion index, low- and high-frequency flaxmotions contribution and increasing of high-frequency flaxmotion contribution. During the eGFR decreasing in the main group a simultaneous decreasing of low-frequency flaxmotion contribution and flaxmotion index, also with increasing of high-frequency flaxmotions contribution and intravascular resistance shows to stazic form of microcirculatory disorder. Exposed correlations of LDF-indexes with eGFR can show that LDF has potential possibilities for diagnostics and progression assessment of microangiopathic changes. Summary. In patients with diabetes mellitus type 2, a progressive microcirculation failure takes place. With the development of the microangiopathy, a negative influence of venous stasis prevails over the ischemic events. The development of chronic kidney disease is an independent risk-factor of microangiopathic complications of diabetes mellitus type 2. Preclinical diagnostics of renal lesion is important for timely beginning of the protective therapy of severe microvascular complications.

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