Kovalenko О.M., Kozinets H.P., Kovalenko A.O., Boyarska A.M, Osadcha O.I.,
National Medical University by O.O.Bogomolets, Kyiv, Ukraine
National Medical Academy of Postgraduate Education, Kyiv, Ukraine. 
Burn Clinic Kyiv, Ukraine

Introduction: Sepsis and septic shock are the main causes of mortality in patients with severe burns. The search for markers for the early diagnosis of burn sepsis was relevant.
Methods:  48 patients with dermal burns 20-70% TBSA were under supervision. The study group – 30 patients. 70% necrotic tissue was excised within 10 days. Control group – 18 patients, necrotic tissue was excised late.
 Results. Not less than 70% deep and superficial necroses were excised in patients of study group within 10 days after injury. Level of prokalcitonin (PCT) ≤ 2 ng/ml, C-reactive protein (CRP) ≤ 100 mg/l, number of microorganisms in burn wounds ≤104/g, plasma lactate to 2.7 mmol/l were determined. Toxic granulation neutrophils in the peripheral blood (TGN) ≥45% and nitro-blue tetrazolium (NBT) test ≤25%  indicate the presence of a systemic inflammatory response with possible septic complications. The clear correlation noted between blood lactate levels and development of RDS and MOF. Organ dysfunction decreased to 3.6 points SOFA. 
High number of microorganisms burn wounds ≥ 106/g was determened   in the control group of patients and it was correlated with severity to 8.95 points SOFA, CRP - above 200 mg/l, PCT ≥ 10 ng/ml. CRP higher than normal, was 70.1±10.2% of patients. Increased plasma lactate from 2.7 to 4.0 mmol/l indicating  risk zone, more than 4 mmol/l - of sepsis, TGN ≥60% and NBT- test ≥25%  are seen in cases of sepsis with multiple organ failure.
The degree of MOD remained at high level to 8.6 points. High correlation identified with the level MOF and PCT (r1=0,7) and CRP (r2=0,9). 
Conclusions. Result of treatment depends on early surgical tactics. Bacterial colonization wounds in 105/g, PCT level ≥ 2 ng /ml, CRP≥100 mg/l, lactate ≥ 4 mmol /l TGN ≥60% and NBT- test ≥25%  are seen in cases of sepsis with multiple organ failure.

1 - Early diagnosis of burn sepsis