Severity of sepsis in patients with acute purulent destructive pulmonary disease depending on the presence of type 2 diabetes: impact on the forecast

Introduction

Lung abscesses and gangrene are the most severe clinical manifestation and outcome among acute purulent destructive pulmonary disease (APDPD). Mortality ranges from 10 to 35%, and in the presence of diabetes increases up to 30 to 90% [1]. The main reason for this is the generalization of infection (sepsis), leading to the development of multiple organ failure [2, 3]. The aim of this study was to identify the severity of sepsis in patients with APDPD depending on the presence of type 2 diabetes, and the impact on the forecast.

Methods

During the period 2012 to 2013, we examined 408 patients aged 48.5 ± 12.5 years (258 men/150 women) who underwent surgical treatment for APDPD. The patients were divided into two groups: 144 patients with type 2 diabetes, and controls (n = 246). We carried out computed tomography, ECG, echocardiography, laboratory biochemical testing, and bacteriological analysis of pathologic material and blood samples.

Results

Patients with type 2 diabetes had much more complications and cases of severe sepsis and septic shock (Table 1). Bacteriological analysis of the pathologic material showed Gram-positive bacteria in 35 to 45%, anaerobic association in 55 to 65%, pathological fungi in 50 to 60%. The patients with type 2 diabetes had much more time from the onset of the first symptoms of lung disease prior to admission (12.5 ± 3.5 vs. 7.5 ± 2.5 days, P = 0.002), and the duration of inpatient treatment was significantly longer (13.8 ± 5.5 vs. 7.1 ± 3.4 days, P = 0.001). Only 53 (36.8%) of patients with type 2 diabetes and 68 (29.5%) without it had bacteriological positive blood culture. The analysis of the distribution of pathogens in groups is presented in Figure 1. Patients with diabetes had more Candida spp. (Figure 1). Figures 2, Figure 3 and Figure 4 present the X-ray dynamics of a 42-year-old man with lung abscess. Clinical recovery in patients with type 2 diabetes was significantly worthy compared to controls (45 (31.2%) vs. 153 (57.9%)), mortality rate 48 (33.3%) versus 39 (14.7%), respectively.

Table 1 Clinical symptoms and severity of sepsis in patients with acute purulent destructive pulmonary disease depending on the presence of type 2 diabetes

Figure 1

Figure 2

Man, 42 years old, with right lung abscess after admission to the centre

Figure 3

The same patient on the fourth day after drainage of the abscess

Figure 4

The same patient before discharge, 14 days in dynamics.

Conclusion

In patients with acute purulent destructive pulmonary disease and type 2 diabetes, severe sepsis and septic shock more often prevailed, inpatient mortality rate was 2.27 times higher, compared to patients with normal glucose metabolism.