Functional status of the pulmonary detoxification in patients with polytrauma complicated by sepsis

Objective: To assess the functional status of the pulmonary detoxification in patients with polytrauma complicated by sepsis.

Material and Methods: Diagnostic findings (levels of sepsis biomarkers, pro-inflammatory cytokines and the veno-arterial gradient of endogenous intoxication markers in the blood) were analyzed in 50 patients with polytrauma complicated by sepsis (Group 1, the main group). Depending on the severity of the condition, the patients were divided into three subgroups: subgroup 1.1 moderate severity (n = 21); subgroup 1.2 severe degree (n = 20); and subgroup

1.3 extremely severe degree of general condition (n = 9). The data obtained were compared with corresponding data from 30 apparently healthy individuals, who constituted the control group (Group 2, control).

Results: Comparative analysis of the median values of procalcitonin, C-reactive protein, D-dimer, lactate, and interleukins IL-1 and IL-6 in patients across the different subgroups versus the control group revealed a significant elevation of all studied parameters in every subgroup. Specifically, in the subgroup 1.1 these parameters exceeded control values by factors of 556, 88.6, 7.9, 3.9, 65, and 2.7, respectively. In the subgroup 1.2 parameters increased by factor of 1018,

231.6, 19.6, 5.6, 106.4, and 5.5, respectively. In the subgroup 1.3 the values were higher by factors of 2644, 619.8, 28, 7.7, 165.7, and 8.5, respectively. Analysis of MEI parameters showed activation of the pulmonary detoxification function in subgroup 1.1, subcompensation in subgroup 1.2, and decompensation in subgroup 1.3.

Conclusion: In patients with polytrauma complicated by sepsis, ARDS of varying severity develops depending on the degree of organ and systemic dysfunction; against this background, the pulmonary detoxification function becomes impaired in a staged manner: Stage I (compensation) in 42.0% of cases, Stage II (subcompensation) in 40.0%, and Stage III (decompensation) in 18.0%.

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