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Introduction. Kidney and pancreas transplantation is a surgical method for the treatment of patients with diabetes mellitus and terminal diabetic nephropathy. While waiting for surgical treatment, potential recipients receive maintenance hemodialysis. Dialysis initiates the loss of body fluid, which in turn can affect the state of the intraocular structures. Aim. To study the effect of long-term hemodialysis therapy on ophthalmic parameters in patients with terminal diabetic nephropathy. Material and methods. Sixty patients (120 eyes) were examined: group A included 30 patients with end-stage renal failure as a result of diabetic nephropathy, group B included 30 people without systemic and ocular pathologies. The ophthalmological status of group A was assessed at the stage of planned preparation for renal replacement therapy, at 3 and 6 months after the initiation of dialysis. Ophthalmological examination consisted of the use of traditional and special diagnostic methods (microperimetry, photorecording of the fundus, optical coherence tomography angiography). Results. Within 6 months of hemodialysis courses, the following was recorded: a decrease in the thickness of the retina (Me: from 348.5 to 306.1 µm; p

Severe concomitant trauma has been a major demographic and medical problem for many years, being the cause of high mortality of the able-bodied population. The simultaneous formation of an array of destroyed tissues triggers a systemic inflammatory reaction, which, against the background of traumatic and hemorrhagic shock, leads to an imbalance in immune reactivity and predisposes to the development of septic complications. The review presents the basic concepts of post-traumatic reactions and violations of the balance of cellular and humoral immune mechanisms leading to the development of complications.

Acute inflammation of the peritoneum – peritonitis – often develops after injury to hollow visceral organs, intestinal necrosis, failure of anastomosis, or tumor processes. Subsequent microbial contamination of the abdominal cavity leads to infection, in response to which immune mechanisms are activated. The pathogenesis of inflammatory processes in the abdominal cavity and their features are largely determined by the structure and function of the peritoneum, as well as its close connection with the omentum. An important point in resolving peritonitis is to maintain the balance of cytokines, the activity of immunocytes and complement functioning in the immune lymphoid clusters of the peritoneum and omentum, and their collaborative action during inflammation. The review presents data on the structure and function of the peritoneum and omentum, the role of neutrophil, macrophage, lymphocytic links of the immune system, as well as those of pro- and anti-inflammatory cytokines and complement in the development and cessation of acute inflammation in the abdominal cavity.

In this report, we reflected a clinical case of the course of the proliferative stage of diabetic retinopathy in a patient suffering from type 1 diabetes mellitus (DM) and end-stage diabetic nephropathy (DN) before and after simultaneous pancreas and kidney transplantation. As a result of successful surgical treatment of DM and DN was achieved physiological normoglycemia (change in fasting blood glucose from 11 to 5.1 mmol/l, glycated hemoglobin level from 9.2 to 5.7 %) and relief of uremic syndrome (change in serum creatinine from 632 to 77,5 µmol/l, urea from 13 to 6 mmol/l, glomerular filtration rate from 7.1 to 83.5 ml/min/1.73 m2). By the end of the first year of the post-transplantation period according to ophthalmoscopy data on the fundus no regression of the initial and addition of new diabetic changes was recorded and according to special instrumental methods of research was recorded a partial improvement hemoperfusion in superficial (an increase in the whole perfusion density: OD — from 24 to 35 %; OS — from 23 to 33 %) and deep (increase in the whole perfusion density: OD — from 5 to 13 %; OS — from 4 to 6 %) capillary plexus, a decrease in the central thickness of the retina (OD — from 269 to 257 µm; OS — from 271 to 253 µm) with resorption of intraretinal fluid in the right eye, improvement of the visual acuity (OD — from 0.5 to 0.7; OS — 0.6 to 0.7) and light sensitivity (macula light sensitivity threshold: OD — from 16.5 to 21.8 dB; OS — from 22.1 to 25.4 dB) of both eyes.

The leading positions in terms of frequency, severity of the course and high mortality belong to infectious forms of acute pancreatitis. However, not all pathophysiological mechanisms of the development of this disorder have been studied. Given that immune responses are an integral part of the pathogenesis of pancreatitis, it is extremely important to study the relationship between the mechanisms of inflammation and activation of the immune response. This review will discuss the role of various populations of innate immune cells, including macrophages, neutrophils, dendritic and mast cells, and regulatory immune cells in the pathogenesis of gland tissue destruction and the relationship between immune responses and systemic inflammatory response syndrome. Targeting innate immune cell populations and metabolite signaling pathways in acute pancreatitis may lead to a broader and ultimately more effective redirection of the treatment program towards disease resolution and improved clinical outcomes.

Diabetes mellitus (DM) is one of the most common and rapidly progressing diseases worldwide. Diabetic retinopathy (DR) is a common complication of diabetes and the main cause of vision loss in middle-aged and elderly people. The development and progression of DR is closely related to the duration of diabetes, hyperglycemia, and arterial hypertension. There is growing evidence that inflammation is one of the key links in the pathogenesis of diabetic retinal damage, but the exact molecular mechanisms remain to be known. Pancreas transplantation (PT) is currently the only effective treatment for diabetes that restores normal physiological glucose metabolism. Due to the limited number of PT surgeries associated with the severity of intra- and postoperative complications and the acute issue of organ donation, studies on the assessment of DR after PT are few and contradictory. There is a need for further studies of the DR state after PT with the study of the influence of risk factors, determination of the level of immunological markers and the use of modern instrumental research methods to create effective patient management regimens in the postoperative period.

Diabetes mellitus is a serious health problem in both developed and developing countries. It is expected that by 2040 the incidence of diabetes mellitus in the world will increase to 642 million people. With the increase in the incidence of diabetes mellitus, the incidence of diabetic vascular complications increases, which worsen the quality of life of patients and triple the risk of death. Diabetic retinopathy is one of the most common microvascular complications of diabetes mellitus, leading to progressive loss of visual function. Diabetic retinopathy occurs in conjunction with diabetic nephropathy. This fact is associated with the anatomical similarity of the blood-retinal barrier and the glomerular filtration barrier, as well as with the general pathogenetic mechanisms of the effect of hyperglycemia on peripheral microcirculation. On average, after 10–15 years, patients with decompensated diabetes mellitus develop end-stage renal failure, requiring renal replacement therapy, such as peritoneal dialysis, programmed hemodialysis, and kidney transplantation. This article highlights the latest data on the effect of programmed hemodialysis on the morphofunctional state of the retina in patients with diabetes mellitus.

Background Sepsis and septic shock are formidable and complications in surgery with mortality 20–50%. In the pathogenesis of sepsis, a significant role belongs to bacterial endotoxin (LPS - liposaccharide).Aim of study Assessment of the efficacy of selective lipopolysaccharides hemosorption (SLH) in treatment of sepsis.Material and methods We examined 65 patients with developed sepsis or suspected presence of gram-negative infection. Patients were retrospectively divided into two groups. In Group 1, 27 patients received Polymyxin B hemoperfusion using Toraymyxin cartridges. In Group 2 (38 patients), adsorber Alteco (LPSA) was used.Results It was established that 28-day mortality was 11.1% in Polymyxin group and 28.9% in LPS group A, p = 0.091, 60-day mortality was 33.3 and 55.3%, respectively (p=0.065). The use of SLH contributed to a decrease in the activity of endotoxin (EAA) from 0.52 (0.39; 0.65) to 0.40 (0.36; 0.57) EU (p=0.330) in Polymyxin group and from 0.59 ( 0.42; 0.72) to 0.54 (0.40; 0.81) EU ( p = 0.981) in the LPS-A group. At the same time, the level of procalcitonin (PCT) in the blood statistically significantly decreased from 8.4 (3.6; 29.0) to 4.8 (1.9; 36.3) ng/ml (p=0.0117) only in the LPS-A group. The level of C-reactive protein (CRB) in the blood statistically significantly decreased only in the Polymyxin group, from 205 (154; 264) to 162 (106; 202) mg/L (p

I.V. Vorobyeva1, E.V. Bulava1, L.K. Moshetova1, A.V. Pinchuk2–4 1Russian Medical Academy of Continuous Professional Education, Moscow, Russian Federation 2N.V. Sklifosovskiy Research Institute for Emergency Medical Aid, Moscow, Russian Federation 3A.I. Yevdokimov Moscow University of Medicine & Dentistry, Moscow, Russian Federation 4Research Institute of Public Health Organization and Medical Management, Moscow, Russian Federation Type 1 diabetes (T1D) is one of the most common chronic diseases in young individuals. Diabetic nephropathy, being one of the most dangerous complications of T1D, progresses to end-stage renal disease within 10–15 years in 80%. The simultaneous kidney-pancreas transplant prevents insulin therapy and dialysis, thereby avoiding further progression of complications of diabetes. Normalization of carbohydrate metabolism and resolving of uremia after simultaneous kidney-pancreas transplant are beneficial for ocular structures. This article reviews studies on the pattern of changes in ocular structures in the post-transplant period. The procedure improves peripheral microcirculation of the bulbar conjunctiva and corneal innervation. Most studies demonstrate stabilization and improvement of the course of diabetic retinopathy as illustrated by the reduction in active vascular proliferation, need for retinal laser photocoagulation and vitrectomy. Meanwhile, some studi es failed to reveal any differences in the morphological functional status of the retina in the pre- and postoperative periods. An increase in cataract rate among simultaneous kidney-pancreas transplant recipients receiving immunosuppressant therapy remains a challenge. Keywords: type 1 diabetes, kidney transplant, pancreas transplant, simultaneous kidney-pancreas transplant, diabetic retinopathy, diabetic macular edema. For citation: Vorobyeva I.V., Bulava E.V., Moshetova L.K., Pinchuk A.V. Ocular changes after simultaneous kidney-pancreas transplant. Russian Journal of Clinical Ophthalmology. 2022;22(2):132–136 (in Russ.). DOI: 10.32364/2311-7729-2022-22-2-132-136.

The article presents data on the study of neurogenetic changes in the rat brain and the features of performing various behavioral acts during acquisition of a food-acquisition skill, depending on the actualization of the previously acquired skill. The experiments involved 13 animals who were successively trained in the following behaviors: new context in the open field test, new objects in the object preference test, drinking behavior using a vibrissal pad, and food-acquisition behavior of pressing the pedal. It turned out that the nature of motor activity and the severity of neurogenetic changes during learning a new skill in individuals who immediately before this training occurred short-term actualization of the experience formed at one of the previous stages of training, significantly differed from the same parameters in individuals who did not have such actualization. It is suggested that the actualization of previously formed experience before new training contributes to the formation of a new component of experience, but not in the sense of accelerating the formation of new behavior, but in the aspect of increasing the number of active neurons that change the expression of their genes.

E.A. Karavaeva1, T.E. Taranushenko2, A.V. Morgun2, M.V. Borisova1, T.G. Kadricheva1, T.I. Bulava1, N.A. Gonchar1, E.A. Guseynova1 1Krasnoyarsk Regional Clinical Center for Maternal and Child Welfare, Krasnoyarsk, Russian Federation 2Prof. V.F. Voino-Yasenetsky Krasnoyarsk State Medical University, Krasnoyarsk, Russian Federation Aim: to assess the rate of detection and epidemiology of renal tumors in children of the Krasnoyarsk Krai and to specify some tumor characteristics during primary diagnostics. Patients and Methods: retrospective exploratory (pilot) dynamic single-center study was conducted. A group of 46 children and adolescents with renal tumors who were admitted to the Department of Hematological Malignancies for examinations and treatment in 2011–2019. All data were obtained from hospital register. Results: renal tumors account for 6.4% of hematological malignancies first diagnosed in children. 9-year primary incidence of renal tumors in children was, on average, 0.87 per 100,000 children, alternating between the increase and decrease in the detection rate. Renal tumors rank 4th among hematological malignancies in the Krasnoyarsk Krai children. The mean age was 4.1±0.5 years. No gender differences were revealed. In a pre-hospital setting, renal tumors were suspected in 24 children (52%). The most common complaints were abdominal pains (34 patients, 74%) and enlarged abdomen (30 patients, 65%). Most renal tumors (40 out of 46) were nephroblastoma as demonstrated by histology. The distribution by prognostic risk (the likelihood of recurrence and/or other unfavorable outcome) has shown that most patients have intermediate (n=25, 54%) or high (n=19, 42%) risk. Conclusions: our findings illustrate that children with renal tumors require more attention of pediatricians in a pre-hospital setting (cancer vigilance about abdominal pains and enlarged abdomen in children) to reduce the time to diagnosis and to increase the use of renal ultrasound during checkups or in suspicious renal tumors. Keywords: nephroblastoma, Wilms tumor, renal tumors, children, epidemiology, prevalence, primary diagnostics. For citation: Karavaeva E.A., Taranushenko T.E., Morgun A.V. et al. Renal tumors in children and adolescents (primary diagnostics based on a pilot study) . Russian Journal of Woman and Child Health. 2021;4(2):162–167. DOI: 10.32364/2618-8430-2021-4-2-162-167.

I.V. Vorobyeva1, L.К. Moshetova1, A.V. Pinchuk2–4, Е.V. Bulava1, Е.P. Delver5, А.А. Belogurov5 1Russian Medical Academy of Continuous Professional Education, Moscow, Russian Federation 2N.V. Sklifosovskiy Research Institute for Emergency Medical Aid, Moscow, Russian Federation 3A.I. Evdokimov Moscow University of Medicine & Dentistry, Moscow, Russian Federation 4Research Institute of Public Health Organization and Medical Management, Moscow, Russian Federation 5National Medical Research Center of Cardiology, Moscow, Russian Federation Epidemics of diabetes and its complications is a global threat to the health of human population. In 2040, the number of patients with diabetes is predicted to rise to 642 million. Diabetic retinopathy and nephropathy are the most dangerous complications. Chronic hyperglycemia is a major factor that determines the development and progression of microvascular complications of diabetes including retinopathy and nephropathy. Key biological pathogenic mechanisms of microvascular complications involve over-production of reactive oxygen species and activation of intracellular signaling pathways and their modulators. OCT angiography is a safe and informative early diagnostic tool to assess vascular retinal abnormalities and to monitor treatment efficacy. Proteinuria was long considered the gold standard to evaluate and monitor kidney functions. However, one-third of patients develop diabetic nephropathy in normal albuminuria. Degradation products of glomerular filtration barrier are thought to be perspective biomarkers of early diabetic nephropathy. End-stage renal disease requires kidney transplantation. In addition to the improvement of uremic syndrome, kidney transplantation favors the course of diabetic retinopathy. Keywords: diabetes, diabetic retinopathy, diabetic nephropathy, optical coherence tomography, OCT angiography, kidney transplantation. For citation: Vorobyeva I.V., Moshetova L.К., Pinchuk A.V. et al. Common pathogenic aspects of diabetic retinopathy and nephropathy. Kidney transplantation and the course of diabetic retinopathy. Russian Journal of Clinical Ophthalmology. 2021;21(2):90–95. DOI: 10.32364/2311-7729-2021-21-2-90-95.

Background There is still no information on the dynamics of pro- and anti-inflammatory cytokines and mark-ers of the septic process before the clinical manifestation of sepsis. The aim of the study was to analyze the dynamics of inflammation and sepsis markers concentration in early periods in patients with urgent pathology, depending on the subsequently developed sepsis. Materials and methods. The concentration of procalcitonin, C-reactive protein, LBP, IL-6, IL-10, IL-2R in 61 patients with a high risk of sepsis was investigated starting from the first day after admission to the hospital and then with intervals of 3–5 days. The Group 1 included 29 patients with verified sepsis. All patients of this group survived. The Group 2 included 8 patients who died. The Group 3 included 24 patients who had no clinical signs of sepsis. All the patients in this group recovered. Results. We revealed significant differences in concentrations of systemic inflammatory response markers and its dynamics in the period preceding clinical manifestations of sepsis. It was found that it was possible to predict the development of sepsis and its unfavorable outcome with a high statistical probability in the study of paired samples of blood serum of patients received on day 1–3 and 4–6 from the onset of the disease or severe trauma. The predictors were multidirectional changes of IL-6, IL-10, LBP concentrations and more than three-fold IL-2R increase on the background of high concentrations of procalcitonin and C-reactive protein. Conclusion. The highest concentrations of procalcitonin, C-reactive protein, IL-10 and IL-2R were revealed within the first three days in patients who died of sepsis. High concentrations of IL-6 and IL-10 within first three days and different directions of their concentrations during the next 4–6 days indicate the development of sepsis with an unfavorable outcome. Reduction of IL-2R and IL-6 and an increase in IL-10 within the first week after the onset of the disease or trau-ma are predictors of lethal outcome.

Modeling of immune tolerance will eliminate the need for taking medications to prevent rejection. This review of available literature covers the immune mechanisms of allograft rejection and the ways of tolerance induction. The role of mesenchymal stem cells and using them for tolerance development have been discussed. The authors also draw attention to the fact that blood transfusion from an organ donor leads to a decreased intensity of the immune response to donor cells in transplantation.

Background. Given that the imbalance in pro- and anti-inflammatory cytokines plays an important role in the pathogenesis of sepsis, estimation of its prognostic value in patients in the early stages from the disease onset or injury is of concern.Aim of study. To study changes in concentrations of biomarkers for inflammation on day 1–2 in patients with a high risk for sepsis.Materials and methods. On day 1-2 from the admission, blood tests were performed in 48 patients with a high risk of sepsis: 9 — with mediastinitis, 6 — with widespread purulent peritonitis, 24 — with severe concomitant injury, 9 — with acute destructive pancreatitis. Sepsis occurred in 28 patients of group 1. Group 2 consisted of 20 patients without sepsis. We investigated concentration of procalcitonin, C-reactive protein, interleukine-6 and -10, lipopolysaccharide-bindidng protein and soluble receptor for interleukine-2.Result. Significant differences in concentrations of groups were identified on day 1-2 in CRP (P=0.00009), IL-2R (P=0.0005) LBP (P=0.00002) and IL-6 (P=0.0192).Conclusion. Hyper LBP and CRP on the background of high IL-2R, IL-6, increase the risk of sepsis.

ABSTRACT. The paper describes the first experience of successful small bowel transplantation in the Sklifosovsky Research Institute for Emergency Medicine. It contains a brief review of literature on essential aspects of small bowel transplantation, presents the donor’s case history, specific features of anesthesia, surgical procedure, and postoperative course, including the immunosuppression scheme, diagnosis and treatment of evolved complications. The paper provides in-detail results of morphological control over rejection development, presents the data of ultrasonographic observation of the changes in the transplanted intestine in the course of its adaptation to new requirements, covers the tactics of parenteral and enteral nutrition.

ABSTRACT. Assessment of the immune status of patients with urgent types of pathology in the Institute for Emergency Medicine is performed according to three main objects of research: humoral , phagocytic and lymphocytic components of immune system . This complex allows to fully and adequately evaluate the condition of the immune system of patients at different stages of traumatic disease and after transplantation of organs and tissues , to forecast the probability of septic complications developing, adjust the therapy . During 45 years of work of immunological service formed the algorithm of the adequate immunological screening was formed, number of innovative methods of diagnosis was developed, the ideology of post-test counseling of patients by immunologists was created, mathematical methods of storage, modeling and processing of research results was introduced. Laboratory staff identified a number of medical and social factors in the spread of blood-borne viral infections (HIV, hepatitis B and C). New organizational and economic methods of management team were introduced in the laboratory. The basis of the work is equal integration of scientific and clinical staff of the laboratory.

Immunological aspects of sepsis (review of foreign literature).

The paper describes the first case of successful small bowel transplantation in the Sklifosovsky Research Institute for Emergency Medicine. It contains a brief review of literature on essential aspects of small bowel transplantation, presents the donor’s case history, specific features of anesthesia, surgical procedure, and postoperative course, including the immunosuppression scheme, diagnosis and treatment of evolved complications. The paper provides in-detail results of morphological control over rejection development, presents the data of ultrasonographic observation of the changes in the transplanted intestine in the course of its adaptation to new requirements, covers the tactics of parenteral and enteral nutrition.

Objective: to evaluate the efficiency of early immune replacement therapy (EIRT) in patients with severe polytrauma (SCI).Subjects and methods. Two hundred and twentyfive victims aged 35.5±14.1 years with SCI (ISS>30 scores), including 158 cases of nosocomial pneumonia, were examined. According to the use of EIRT with donor immunoglobulin (IgG) (daily within the first three days), the patients were divided into two groups: 1) standard intensive treatment was added by EIRT (n=126) and 2) that without EIRT (n=99). Immunological examination was performed on days 1, 3, 6, and 9 after injury. The investigators determined the relative and absolute counts of major lymphocyte populations: T (CD3+) and B (CD19+) lymphocytes, those of T cell populations: (CD4+) helper T cells and (CD8+) cytotoxic T lymphocytes, the concentrations of the immunoglobulins A, O, and M classes (IgA, IgG and IgM), neutrophil absorptive and bactericidal activities, and the serum levels of large, middle, and small circulating immune complexes, Creactive protein, and procalcitonin. The incidence of nosocomial pneumonia and sepsis and the outcome of injury were analyzed in both groups. Results. The performed investigation indicated that EIRT in Group 1 victims resulted in a 27.6% decline in the number of patients who had received mechanical ventilation (MV) for more than 3 days and reduced the rate of earlyonset pneumonia and sepsis by 24.3 and 5.2%, respectively, and the intensive care unit length of stay from 20.2 to 12.5 days, mortality rates by 12.1%, and deaths by 1%.Conclusion. EIRT used to treat victims with SCI could decrease the duration of MV and the incidence of nosocomial pneumonia, which in turn reduced mortality rates in the examined groups.

Polytrauma is a serious threat to human life not only due to its direct damage to vital organs, but also to the development of significant oxidative distress that gives rise to multiple organ dysfunction. At the same time, the risk of lifethreatening infectious complications increases.Objective: to study oxidative distress over time and its association with early pulmonary infectious complications in patients with polytrauma.Subjects and methods. The authors examined 35 patients with polytrauma in the first 6—12 and 12—24 hours and 3, 5—7, and 10 days after injury and 25 healthy volunteers. Having regard to the development of pulmonary infectious complications, they formed two comparison groups of patients: 1) 15 patients without pneumonia and 2) 20 patients with pneumonia. The investigation used the antioxidant index (AOI) considering the activity of erythrocyte enzymes (superoxide dismutase, catalase, glutathione peroxidase, and glutathione reductase) and the degree of lipid peroxidation in the plasma (dienic conjugates and malonic dialdehyde) to estimate the balance between oxidative lesions and the performance of the body's antioxidant systems.Results. In both groups, the AOI reflects the oxidative stress state, as substantiated by negative values for the AOI with its normal value equal to zero. However, with the virtually parallel nature of AOI changes after injury in the patients with pneumonia, the values of the index were significantly lower than in those without complications within the first 6—12 and 12—24 hours and 5—7 days (p

The components of mitochondria from the cells damaged by injury are a key component for the development of systemic inflammatory response syndrome (SIRS) under aseptic conditions. At the same time, there is a significant increase in the plasma level of mitochondrial DNA (mtDNA), which may be a prognostic marker for infectious complications in patients with severe polytrauma. Objective: to study the time course of changes in the serum levels of mtDNA and nuclear DNA (nDNA) in healthy individuals and patients with polytrauma and to reveal its possible association with the development of infectious pulmonary complications and with mortality. Subjects and methods. Seven healthy volunteers and 25 polytrauma with polytrauma of a mean injury severity score (ISS) of 40.2±9.2. Sixteen (64%) patients developed purulent tracheobronchitis and pneumonia; 5 (20%) patients died. The amount of mtDNA and nDNA was determined within the first at 12 and 24 hours, then on days 3 and 5—7 after injury by the authors’ modified procedure using as the exogenous control of a circular DNA molecule. The content of mtDNA and nDNA was expressed as absolute values, by taking the arithmetic mean values as 100% for the volunteers. Results. There was a more than 2.5-fold increase in mtDNA levels in dead patients as compared to survivors (p

Background. The posttraumatic period in victims with severe concomitant injury is frequently complicated by nosocomial pneumonia, resulting in high mortality rates and longer time and increased cost of treatment in intensive care unit unit patients. Procalcitonin (PCT) is considered to be a marker for infectious complications due to different critical conditions; however, its prognostic value for different patient categories and periods after injury remains unclear; elevated PCT levels maybe related to the development of pneumonia in view of the severity of injury and the duration of mechanical ventilation (MV). Objective: to establish a correlation between the time course of changes in PCT levels and the development of nosocomial pneumonia and sepsis in victims with severe concomitant injury in relation to its severity and the duration of MV. Subjects and methods. The case histories of 271 victims with severe concomitant injury treated in the Intensive Care Unit, N. V. Sklifosovsky Research Institute of Emergency Care, in 2008—2012 were retro- and prospectively analyzed. The admission PCT level and its changes were analyzed in relation to the severity of injury and secondary infectious complications. Severe concomitant injury was ascertained to be accompanied by elevated serum PCT levels. A correlation was found between injury severity, mortality, the development of infectious pulmonary complications, sepsis, and mean PCT levels. The more severe the injury, the higher serum PCT level was revealed. In the first 12 hours, a group of victims without pneumonia exhibited the highest PCT levels (1.91±0.51 ng/ml). Later on there was its smooth fall and normalization by days 3—5. In the group of victims with pneumonia, but without sepsis, the PCT level averaged 1.71±0.64 ng/ml just in the first 6 hours, then its concentration continued to rise and its maximum level (3.93±1.26 ng/ml) was recorded in the first 48 hours. Later on, its decrease and normalization were observed by day 6 if the course of disease was favorable. A distinct pattern was seen in the group of victims with pneumonia and sepsis. Just in the first 6 hours, the mean level of PCT was 6.98±1.3 ng/ml and then its concentration continued to increase to 22.7±7.8 ng/ml in the first 48 hours. ROC analysis revealed the most prognostic effect of PCT at risk for pneumonia in the range from 12 to 24 hours since the ROC curve area was 0.753, which was good, as estimated by experts, and the cut-off was 1.79 ng/ml; moreover, sensitivity was 69.7% and specificity was also 69.7%. Conclusion. It is shown that it is expedient to monitor PCT levels in patients with severe concomitant injury from the admission of victims to hospital. The PCT concentration of more than 1.79 ng/ml during the first 12 hours after injury can serve as an early predictor for nosocomial pneumonia with a risk for further generalization of the process in victims with severe concomitant injury. Key words: severe concomitant injury, procalcitonin, infectious complications, pneumonia, sepsis, biomarker, predictor, mortality, ISS, mechanical ventilation.