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

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.