OBJECTIVE
To evaluate the importance of determining the level of procalcitonin (PCT) and presepsin (PSP) in early diagnosis, prognosis, and evaluation of the effectiveness of antibiotic therapy in patients with obstetric sepsis.
MATERIAL AND METHODS
The scientific research program was carried out on the basis of the Bukhara Regional Perinatal Center and the maternity complex of the Bukhara region in conjunction with the Department of Obstetrics and Gynecology No. 2 of the Bukhara State Medical Institute. An in-depth examination of 90 maternity hospitals was conducted, which were divided into 3 groups: the 1st main group consisted of 30 patients with obstetric sepsis, which underwent timely and adequate treatment of severe postpartum disease according to a standard protocol with the addition of blood plasmapheresis using the HE-MOS device. The 2nd main group included 30 women with obstetric sepsis, for whom standard treatment to prevent postpartum septic complications was not carried out in time, and standard antibacterial immunocorrective therapy according to the protocol of the Republic of Uzbekistan was carried out of time. The 3rd, control group included 30 postpartum patients with the physiological course of pregnancy, childbirth and the postpartum period. The blood plasma levels of biomarkers for the generalization of the bacterial infectious process — procalcitonin and presepsin — were determined upon admission to the hospital and every 3 days after the beginning of complex therapy with antibacterial drugs using reagent kits based on immunofluorescence analyzers.
RESULTS
A comparative analysis of the levels of PCT and PSP in the 1st and 2nd main groups revealed that they were statistically significantly higher than in the control group (p<0.05). The concentration of PCT in patients of the control group was in the range of 0.05—0.50 ng/ml, in infants of the 1st and 2nd groups in the initial stages of the infectious process reached 2.0—7.0 ng/ml. The PSP concentration at admission in the main groups of patients with clinical symptoms of postpartum infection was on average 4 times higher than the reference values (1120.54±183.63 pg/ml at a rate of up to 320 pg/ml). High levels of PSP were combined with the severity of the clinical course of sepsis and the activity of toxic and infectious manifestations (fever, etc.). The maximum levels of PSP were noted in mixed infections; in addition, the levels of PCT and PSP were statistically significantly higher in patients with severe obstetric sepsis (p<0.05).
CONCLUSION
The results showed that if PSP levels remain high, despite the normalization of PCT and resolution of clinical symptoms of postpartum sepsis, the possibility of disease recurrence should be predicted and the need for continued antibacterial therapy should be addressed with careful monitoring of patients to determine the dynamics of the clinical course of the septic process.
