Opinion paper on innovative approach of biomarkers for infectious diseases and sepsis management in the emergency department

Abstract

Sepsis is a leading healthcare problem, accounting for the vast majority of fatal events in critically ill patients. Beyond early diagnosis and appropriate treatment, this condition requires a multifaceted approach for monitoring the severity, the potential organ failure as well as the risk of death. Monitoring of the efficacy of treatment is also a major issue in the emergency department (ED). The assessment of critically ill conditions and the prognosis of patients with sepsis is currently based on some scoring systems, which are, however, inefficient to provide definite clues about organ failure and prognosis in general. The discretionary and appropriate use of some selected biomarkers such as procalcitonin, inducible protein 10 (IP10), Group IV phospholipase A2 type II (PLA2 II), neutrophil gelatinase-associated lipocalin (NGAL), natriuretic peptides, mature adrenomedullin (ADM), mid-regional pro-adrenomedullin (MR-proADM), copeptin, thrombopoietin, Mer receptor and even red blood cell distribution width (RDW) represent thereby an appealing perspective in the diagnosis and management of patients with sepsis. Nevertheless, at the moment, it is not still clear if it is better to use a multimarkers approach or if a single, most appropriate, biomarker exists. This collective opinion paper is aimed at providing an overview about the potential clinical usefulness of some innovative biomarkers of sepsis in its diagnosis and prognosis, but also in the treatment management of the disease. This manuscript represents a synopsis of the lectures of Third Italian GREAT Network Congress, that was hold in Rome, 15-19 October 2012.

Copeptin (CTproAVP), a new tool for understanding the role of vasopressin in pathophysiology

“…Results from the BACH study also showed that patients with elevated CTproAVP and the lowest levels of sodium had the highest mortality at 90 days. Combined end points of mortality, readmissions and emergency department visits were also associated with higher CTproAVP [37,40].…”

The Existence of Continuous Systemic Inflammation in Pregnant Women with Hyperemesis Gravidarum

“…Recent studies have demonstrated that pregnant women with HG have higher inflammatory markers when compared to healthy pregnant women without HG in the first trimester. Measuring white blood cell count (WBC), neutrophil-to-lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), and red blood cell distribution width (RDW) is an inexpensive and convenient way to identify systemic inflammation in the body (12)(13)(14)(15). Studies have shown that NLR, PLR, and RDW values are highly associated with the prognosis of diseases related to inflammation (16)(17)(18)(19).…”

Biomarkers for sepsis: an unfinished journey

“…In this issue of Clinical Chemistry and Laboratory Medicine , Di Somma et al [ 12 ] provide an overview about the potential clinical usefulness of some biomarkers of sepsis. This opinion article represents a synopsis of the lectures on biomarkers and sepsis of the Third Italian GREAT Network Congress, which was held in Rome, 15 -19 October 2012.…”

“…In ref. [ 12 ], the authors discuss not only the biomarkers already standardized and actually used in clinical practice but also some biomarkers that are still tested for experimental use.…”

“…[ 12 ], the rapid diagnosis of sepsis in emergency departments is often difficult because the symptoms are rather not specific. Among the huge number of biomarkers proposed [ 4 -8 , 12 ], only procalcitonin (PCT) complies with most of the desirable preanalytical, analytical, and postanalytical features for an ideal laboratory biomarker ( Table 2 ).…”