ORGAN FAILURE AND ENDOTHELIAL DYSFUNCTION IN PATIENTS WITH STRETOCOCCAL SURGICAL INFECTION OF SKIN
Preclinical diagnostics of the organ failure is one of the ways to preclinical diagnosis of sepsis in patients with surgical infections, according to the approaches of the Sepsis-3 concept. Such markers are markers of endothelial dysfunction. The aim of the study was to assess the degree of endothelial damage based on the determination of the level of free vascular adhesion molecules in comparison with the severity of patients with severe of streptococcal soft tissue infection. The clinical course of streptococcal infection and the level of free vascular adhesion molecules (sICAM-1, sVCAM-1, sE-selectin) in 76 patients with erysipelas were studied. In patients with severe forms of streptococcal infection, at the time of admission, there is a significant increase in the plasma level of sICAM-1 (from 1.8 to 6 times higher than normal values, M - 722 ng / ml). At the same time, in the groups of patients with organ dysfunction and in the group of patients with SIRS, sICAM-1 values are approximately 1.5 times higher in patients with sepsis, p <0.01, M - 1270 ng / ml). The level of sVCAM-1 increases eightfold (M 2500 ng / ml), but there are no significant differences in the indicator in the groups of systemic inflammatory response and sepsis. The sE-selectin values were significantly higher in the group of patients with organ failure (M 500 ng / ml versus 700 ng / ml in sepsis p <0.01). At the time of clinical recovery, the sE-selectin level normalizes though sICAM-1 and sVCAM-1 levels are still increased. That becomes a molecular morphological substrate for the onset and progression of inflammatory changes in the development and aggravation of the phenomena of lymphovenous insufficiency of the lower extremities, and increases the risk of recurrence of streptococcal infection.