The Role of Mid-Regional Proadrenomedullin in the Differential Diagnosis between Culture-Negative and Culture-Positive Sepsis at Emergency Department Admission
Filippo Mearelli,
Giulia Barbati,
Francesca Spagnol,
Alessio Nunnari,
Luigi Mario Castello,
Enrico Lupia,
Maria Lorenza Muiesan,
Salvatore Di Somma,
Gian Carlo Avanzi,
Gianni Biolo
Affiliations
Filippo Mearelli
Unit of Internal Medicine, Department of Medical Surgical and Health Sciences, University of Trieste, Strada di Fiume 447, 34149 Trieste, Italy
Giulia Barbati
Biostatistics Unit, Department of Medical Surgical and Health Sciences, University of Trieste, Strada di Fiume 447, 34149 Trieste, Italy
Francesca Spagnol
Unit of Internal Medicine, Department of Medical Surgical and Health Sciences, University of Trieste, Strada di Fiume 447, 34149 Trieste, Italy
Alessio Nunnari
Unit of Internal Medicine, Department of Medical Surgical and Health Sciences, University of Trieste, Strada di Fiume 447, 34149 Trieste, Italy
Luigi Mario Castello
Unit of Emergency Medicine, Department of Translational Medicine Eastern Piedmont, University of Novara, Corso Giuseppe Mazzini 18, 28100 Novara, Italy
Enrico Lupia
Unit of Emergency Medicine, Department of Medical Sciences, University of Turin, Corso Bramante 88, 10126 Turin, Italy
Maria Lorenza Muiesan
Unit of Internal Medicine, Department of Clinical and Experimental Sciences, University of Brescia, Piazzale Spedali Civili 1, 25123 Brescia, Italy
Salvatore Di Somma
Unit of Emergency Medicine, Department of Medical Surgery Sciences and Translational Medicine, University “Sapienza” of Rome, Via di Grottarossa 1035/1039, 00189 Rome, Italy
Gian Carlo Avanzi
Unit of Emergency Medicine, Department of Translational Medicine Eastern Piedmont, University of Novara, Corso Giuseppe Mazzini 18, 28100 Novara, Italy
Gianni Biolo
Unit of Internal Medicine, Department of Medical Surgical and Health Sciences, University of Trieste, Strada di Fiume 447, 34149 Trieste, Italy
Background: The host response in culture-negative sepsis (CnS) has been marginally explored upon emergency department (ED) admission. It would be of paramount importance to create a clinical prediction rule to support the emergency department physician in identifying septic patients who can be treated with antibiotics immediately without waiting time to draw cultures if they are unlikely to provide useful diagnostic information. Methods: A multivariable logistic regression analysis was applied to identify the independent clinical variables and serum biomarkers of the culture-negative status among 773 undifferentiated septic patients. Those predictors were combined to build a nomogram predictive of CnS. Results: The serum concentrations of six biomarkers, among the eight biomarkers assayed in this study, were significantly lower in the patients with CnS (449) than in those with culture-positive sepsis (324). After correction for co-variates, only mid-regional proadrenomedullin (MR-proADM) was found to be independently correlated with culture-negative status. Absence of diabetes, hemoglobin concentrations, and respiratory source of infection were the other independent clinical variables integrated into the nomogram—its sensitivity and specificity for CnS were 0.80 and 0.79, respectively. Conclusions: Low concentrations of MR-proADM were independently associated with culture-negative sepsis. Our nomogram, based on the MR-proADM levels, did not predict culture-negative status with reasonable certainty in patients with a definitive diagnosis of sepsis at ED admission.
