Procalcitonin and MR-proAdrenomedullin combination in the etiological diagnosis and prognosis of sepsis and septic shock

• Published in: Microbial pathogenesis Vol. 137; p. 103763
• Main Authors: Spoto, Silvia, Fogolari, Marta, De Florio, Lucia, Minieri, Marilena, Vicino, Giuseppe, Legramante, Jacopo, Lia, Maria Stella, Terrinoni, Alessandro, Caputo, Damiano, Costantino, Sebastiano, Bernardini, Sergio, Ciccozzi, Massimo, Angeletti, Silvia
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01-12-2019
• Subjects: Adrenomedullin - pharmacology; Adrenomedullin - therapeutic use; Adult; Aged; Anti-Bacterial Agents - pharmacology; Bacteria - classification; Bacteria - pathogenicity; Drug Combinations; Etiology; Female; Fungi - classification; Fungi - pathogenicity; Humans; Italy; Male; Middle Aged; MR-proADM; PCT; Procalcitonin - pharmacology; Procalcitonin - therapeutic use; Prognosis; Protein Precursors - pharmacology; Protein Precursors - therapeutic use; Retrospective Studies; ROC Curve; Sepsis; Sepsis - diagnosis; Sepsis - drug therapy; Sepsis - microbiology; Sepsis - mortality; Shock, Septic - diagnosis; Shock, Septic - drug therapy; Shock, Septic - microbiology; Shock, Septic - mortality; Italy; PCT; TRACE; BC; MR-proADM; Prognosis; IL; ROC; IQR; LPS; AUC; IFN; Etiology; CLRs; PPV; LTA; Sepsis; BSI; TLR4; TLR2
• DOI: 10.1016/j.micpath.2019.103763
• EISSN: 1096-1208
• ISSN: 0882-4010

Procalcitonin and Mid-regional pro Adrenomedullin have been proposed for sepsis diagnosis, antibiotic therapy guidance and prognosis. A retrospective analysis of PCT and MR-proADM on 571 consecutive patients with sepsis diagnosis was performed. Median values were compared using the non-parametric Mann-Whitney's test. Receiver operating characteristic analysis was performed to define cutoff points for sepsis diagnosis. Pretest odds, posttest odds, and posttest probability have been calculated. Data were analyzed using Med-Calc 11.6.1.0 software. PCT resulted excellent in gram-negative, but less performant in gram-positive and fungal etiologies. MR-proADM values resulted homogenously distributed within the different microbial classes and increased significantly in septic shock. PCT highest PPV value was found to distinguish gram-negative from fungal sepsis and septic shock (>3. 57 ng/mL, PPV 0.96 and > 8.77 ng/mL, PPV 0.96, respectively). Good diagnostic accuracy was evidenced to discriminate gram-negative from gram-positive septic shock (>3.88 ng/mL PPV 0.89). Lower diagnostic accuracy was evidenced to discriminate gram-negative and gram-positive sepsis (>0.80 ng/mL, PPV 0.78) and gram-positive from fungal septic shock (>1.74 ng/mL PPV 0.75). The lowest PCT PPV (0.28) was found in gram-positive and fungal sepsis distinction. MR-proADM discriminating cut-offs were homogeneously distributed in Gram-negative and Gram-positive sepsis and were higher in septic shock, but not influenced by pathogen etiologies. MR-proADM cut-off values > 3.39 nmol/L in sepsis and >4.33 nmol/L in septic shock were associated with significant higher risk of 90-days mortality. In conclusion, PCT and MR-proADM combination represents an advantage for sepsis diagnosis and for 90-days mortality risk stratification.
•Sepsis is a severe systemic syndrome characterized by high mortality rate.•PCT and MR-proADM can provide useful information at diagnostic and prognostic purposes.•PCT highest PPV value was evidenced to distinguish gram-negative from fungal sepsis and septic shock.•MR-proADM values was homogenously distributed within the different microbial classes increasing significantly in case of septic shock.•PCT and MR-proADM combination represents an advantage for sepsis diagnosis and for 90-days mortality risk stratification.