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Procalcitonin, presepsin, pro-adrenomedullin, fibrin degradation products, and lactate in early diagnosis and prognosis of septic patients newly admitted to the intermediate care unit from the emergency department
© Mearelli et al.; licensee BioMed Central Ltd. 2013
- Published: 5 November 2013
- Receiver Operating Characteristic
- Systemic Inflammatory Response Syndrome
- Septic Patient
- Youden Index
More than 50% of all septic patients admitted to intensive care departments derive from intermediate care units (INCU). Biomarkers represent the most promising tool for early diagnosis of sepsis; but their accuracy in INCU has been largely disregarded . Moreover, given the complexity of the septic pathophysiology, a panel of biomarkers could be more effective than a single one. For this reason we tested acute phase protein, cell surface, vasotonous related, coagulation system, and tissue hypoxia markers in early ruling in/out of sepsis in patients suffering from systemic inflammatory response syndrome (SIRS) [2–5].
This prospective observational study included all SIRS  patients newly admitted to a medical ward from February to May 2012. Cases were diagnosed as sepsis or non-infective SIRS by clinical examination, cultures of the biological fluid, and imaging during a 7-day follow-up. Investigators were blinded to biomarker results. Survivors at 7 and 30 days were also assessed. Samples for procalcitonin (PCT), presepsin (sCD14-ST), pro-adrenomedullin (PRO-ADM), fibrin degradation products (FDP) and lactate were collected within 4 hours of admission. Their role in predicting diagnosis and survival, alone or in combination, have been investigated by receiver operating characteristic (ROC) curve, Youden index, relative risk and binary logistic regression.
FDP + PCT
180 + 0.1 ng/ml
In intermediate care setting patients, the combination of FDP and PCT could be useful for an early discrimination of sepsis from non-infective SIRS. PRO-ADM, sCD14-ST, and lactate should be considered as early indicators of more intensive ward care and precocious ICU admission.
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