Comparative analysis of different types of sepsis

Abstract

Introduction: Sepsis is defined as the systemic inflammatory response to infection. Severe sepsis is considered as the major public health issue. In severe sepsis, local infection is accompanied by systemic neutrophiles activation. Innate immune cells play an important role in pathogenesis of the sepsis. High numbers of blood neutrophils could be due to excessive recruitment from the bone marrow, the return of marginated cells into the circulatory pool or both. The sequestration of neutrophils could be a key stage in the initiation of multiple organ failure and negative evolution of sepsis.The objective of the study: The aim of this study was to examine whether the neutrophiles spectrum changes in different types of sepsis, thus being presumed the evolution of septic process. Materials and methods: A retrospective study was performed on a total of 22 files, aged between 30 -68 years, hospitalized in surgery section “Sf. Treime” hospital from Chisinau in the period 2008 -2010. The analysis of 22 patients who have developed different types of sepsis was made. Patients were divided into three groups: abdominal sepsis (8 files), pulmonary sepsis (8 files) and nephrogenic sepsis (6 files) Results and discussion: Comparative assessment of white blood cell count between abdominal, pulmonary, and nephrogenic sepsis reveals the mild deviation of the formula to the left till myelocytes 25%(3) and metamyelocytes 20% (2.5) in the group with abdominal sepsis 36,3% (8).This may mean that abdominal sepsis activates to a large extent in the regenerative processes of the bone marrow, that is accompanied by further depletion due to rapidly recruited bloodstream to the site of acute inflammation where they die in a large number. The second place is held by both nephrogenic 27,4 % (6) and pulmonary 36,3% (8) sepsis with minimal deviation of leukocytosis to the left. At the same time patients with abdominal sepsis reveal the marked lymphopenia 13,9 which denotes excessive consumption of immunocompetent cells with the subsequent installation of lymphocytopenia. Lethality in the group of patients with abdominal sepsis is clearly increased (75%), indicating the installation of immunodeficiency and determined by lymphocytes anergy and apoptosis, compared with nephrogenic and pulmonary sepsis. This anergy could be explained by depletion of feed-back relation between lymphocytes activity and regenerative capacity of bone marrow. The analysis of the septic process denotes installation of immune disorders within 24 hours of onset whatever the sepsis type. It was mentioned there are no crucial difference of prevalence of one or another type of sepsis. Conclusion: The deviation of WBC to the left characterizes decreased phagocyte capacity of immature in spite of observed leukocytosis. This failure leads to a worsening of septic process. Such patients with primary infectious focus in the abdomen, prevents major risk of septic complications in structure of sepsis morbidity and lethality.