It rises transiently in patients with nonseptic conditions and sy

It rises transiently in patients with nonseptic conditions and systemic inflammatory response syndromes (SIRS) http://www.selleckchem.com/products/AG-014699.html (for example, trauma, surgery, heatstroke) and is not detectable in certain cases of sepsis. Furthermore, biological predictors of mortality are absent, clinical scores appear to be of limited value and the role of PCT as a poor prognostic factor in patients admitted to the ED because of sepsis remains to be proved [7]. The ideal biomarker should retain high sensitivity and specificity and be cost-effective and promptly available.Cluster of differentiation 14 (CD14) is a glycoprotein expressed on the membrane surface of monocytes and macrophages and serves as a receptor for complexes of lipopolysaccharides (LPSs) and LPS-binding proteins (LPBs).

By activating a proinflammatory signaling cascade on contact with infectious agents, CD14 has a role as a pattern recognition molecule in the innate immune response against microorganisms [8]. During inflammation plasma protease activity generates soluble CD14 (sCD14) fragments. One of them, called sCD14 subtype (sCD14-ST), or presepsin, has recently been identified. Presepsin is normally present in very low concentrations in the serum of healthy individuals and has been shown to be increased in response to bacterial infections according to the severity of disease. Moreover, rapid dosage methods, based on chemiluminescence enzyme immunoassay, are available and allow automated measurements in a short time [9,10]. Preliminary studies suggest that the level of presepsin significantly differs in healthy individuals and in patients with local infection, SIRS, sepsis or severe sepsis [11,12].

Presepsin is currently under investigation in clinical practice as a reliable marker of adult and neonatal sepsis [13,14] and for the postmortem diagnosis of sepsis-related death [15].On the basis of these premises, we designed a multicenter prospective study to investigate the diagnostic role and efficacy, together with prognostic power, of presepsin, compared to PCT in an adult population presenting to the ED with SIRS (control group) or suspected sepsis or septic shock (study group).Patients and methodsPatients and design of the studyWe conducted a multicenter prospective study of patients presenting to the ED who met at least two criteria for SIRS and in whom sepsis was suspected to be the primary or concurrent diagnosis.

Informed consent to participate in the study was obtained from the patients or their families, and the study was approved by the Ethics Committee of Turin University Hospital according to the Declaration of Helsinki (1964).The duration of the study was 1 yr. Between January 2012 and January 2013, 189 patients presenting to the EDs of San Giovanni Battista University Hospital and Carfilzomib Major Trauma Center Hospital, both in Turin, Italy, were enrolled.

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