Maria Stella Graziani

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Martina Zaninotto

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Martina Montagnana
Andrea Mosca
Paola Pezzati
Rossella Tomaiuolo
Matteo Vidali

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Articoli con TAG: sepsi

Determinazione della presepsina: non solo diagnosi di sepsi
Presepsin measurement: beyond sepsis diagnosis
<p>As sepsis is the leading cause of death among critically ill patients, early diagnosis is essential for the subsequent treatment to improve the outcome. Several diagnostic pathways have been proposed considering multiparametric approaches that combine clinical and biochemical evaluations. Among the several biomarkers proposed, procalcitonin measurement has been obtained significant consensus particularly in the evaluation of the efficacy of the therapeutic treatment. However, the need to define the prognosis and the outcome and to identify the patients at major risk of events during the hospitalization or at a short time later, seems to be an additional clinical value. The soluble cluster of differentiation 14 (S-CD14-ST or presepsin) is a free fragment of a glycoprotein expressed on monocytes and macrophages; several studies have demonstrated the significative prognostic value of the biomarker blood concentrations (at admission in particular) while the diagnostic performance of presepsin remains unclear. In a study carried out in a population of old patients (67-102 years) suffering from suspected pneumonia (n=50) the results of presepsin at admission in association with a Muldimensional Prognostic Index (MPI) score allow to identify the patients at major risk of adverse events (mortality) within 30 days. The prognostic efficiency of presepsin has been evaluated in different studies confirming, in different patient populations, the additional clinical value of this biomarker. Therefore, presepsin and prolacitonin measurements may provide complementary information that, in addition to clinical score and blood culture or molecular biology, can improve the management of patients with suspected sepsis.</p>
Biochimica Clinica ; 44(1) 068-072
Opinioni - Opinions
La procalcitonina in terapia intensiva: dubbi che rimangono?
Procalcitonin in intensive care: unresolved doubts
<p>Procalcitonin (PCT), a test marketed by some twenty years, is available virtually on all the platforms present in clinical laboratories of any size, even if its precise role is still debated. PCT is requested especially by intensive care units (ICU) and it has been included in algorithms to guide the administration of antibiotics (AB). However, several reports concluded that, despite a theoretical physio-pathological basis, there is no unambiguous evidence that the inclusion of PCT in algorithms is effective to guide AB treatment. In 2012 the Cochrane Collaboration concluded that &ldquo;Further high-quality research is needed to confirm the safety of this approach in intensive care. Moreover, future studies should also establish cost-effectiveness by considering country-specific costs of procalcitonin measurement and potential savings in consumption of antibiotics and other healthcare resources, as well as secondary cost savings due to lower risk of side effects and reduced antimicrobial resistance&rdquo;. In 2015, the National Institute for Clinical Heath Excellence concluded that the test is promising but there is still insufficient evidence to recommend its use to guide the AB treatment of sepsis in ICU. Recently, in a paper published in the Clinical Chemistry journal among the limiting factors preventing widespread use of PCT in sepsis and antibiotic stewardship it was included: the limited availability (and high cost) of PCT, the reluctance showed by clinicians to deescalate antibiotics based on PCT results and the uncertainty about the generalizability of previous studies results. The duration of therapy generally tends to be longer compared to what was recommended by guidelines, and PCT-guided antibiotic discontinuation may be of little benefit in hospitals where duration of therapy is already optimized.</p>
Biochimica Clinica ; 42(2) 146-151
Opinioni - Opinions
Procalcitonina in Terapia Intensiva: più certezze che dubbi
Procalcitonin in intensive care unit: more confidence than hesitation
Biochimica Clinica ; 42(2) 180-182
Lettere all'Editore - Letters to the Editor
Approfondimenti necessari sul liquido cerebro spinale
Insights on the cerebrospinal fluid
<p>The human parechoviruses (HPeV) have recently been recognized as emerging pathogenic microorganisms causing a broad pattern of diseases including sepsis and meningitis in children. A born-at-term, 33-day-old child, was admitted to the hospital with fever, irritability, and loss of appetite. Results of physical examination and routine blood chemistry were unremarkable (no lung rales or skin rashes; normal hemoglobin and leukocyte and platelets counts) with the only exception of an elevated procalcitonin serum level. Examination of the patient&rsquo;s cerebrospinal fluid (CSF) showed pleocytosis, normal glycorrhachia and a mild increase of proteins. Blood and CSF cultures were negative. When tested with a commercial multiplex PCR technology (FILMARRAY&reg;- Biomerieux), CSF turned out positive for the HPeV. Rapid identification of HPeV may contribute to reduce the laboratory turnaround time and improve clinical management. HPeV should be included in the differential diagnosis of young children with central nervous system symptoms and sepsis-like illness.</p>
Biochimica Clinica ; 44(1) e3
Casi Clinici - Case Report