title: Procalcitonin, MR-Proadrenomedullin, and Cytokines Measurement in Sepsis Diagnosis: Advantages from Test Combination.
abstract: BACKGROUND
  Elevated cytokines levels correlate with sepsis severity and mortality but their role in the diagnosis is controversial, whereas Procalcitonin (PCT) has been largely used. Recently, the mid-regional proadrenomedullin (MR-proADM) has been combined with PCT for diagnosis optimization. In this study the combined measurement of PCT, MR-proADM, and cytokines in patients with sepsis was evaluated.
  
  
  METHODS
  One hundred and four septic patients and 101 controls were enrolled. Receiver operating characteristic (ROC) analysis and multiple logistic regression were used to evaluate applicant markers for sepsis diagnosis. Markers with best Odds Ratio (OR) were combined, and the posttest probability and a composite score were computed.
  
  
  RESULTS
  Based upon ROC curves analysis, PCT, MR-proADM, IL-6, IL-10, TNF-α, and MCP-1 were considered applicant for sepsis diagnosis. Among these PCT, MR-proADM , IL-6, and TNF-α showed the best OR. A better posttest probability was found with the combination of PCT with MR-proADM and PCT with IL-6 or TNF-α compared to the single marker. A composite score of PCT, MR-proADM, and TNF-α showed the best ROC curve in the early diagnosis of sepsis.
  
  
  CONCLUSIONS
  The combination of PCT with other markers should expedite diagnosis and treatment of sepsis optimizing clinical management.
authors.affiliation: Clinical Pathology and Microbiology Laboratory, University Hospital Campus Bio-Medico of Rome, 00128 Rome, Italy.
authors.forename: Silvia
authors.initials: S
authors.lastname: Angeletti
authors.affiliation: Clinical Pathology and Microbiology Laboratory, University Hospital Campus Bio-Medico of Rome, 00128 Rome, Italy.
authors.forename: Giordano
authors.initials: G
authors.lastname: Dicuonzo
authors.affiliation: Clinical Pathology and Microbiology Laboratory, University Hospital Campus Bio-Medico of Rome, 00128 Rome, Italy.
authors.forename: Marta
authors.initials: M
authors.lastname: Fioravanti
authors.affiliation: Clinical Pathology and Microbiology Laboratory, University Hospital Campus Bio-Medico of Rome, 00128 Rome, Italy.
authors.forename: Marina
authors.initials: M
authors.lastname: De Cesaris
authors.affiliation: Clinical Pathology and Microbiology Laboratory, University Hospital Campus Bio-Medico of Rome, 00128 Rome, Italy.
authors.forename: Marta
authors.initials: M
authors.lastname: Fogolari
authors.affiliation: Department of Infectious, Parasitic, and Immune-Mediated Diseases, Epidemiology Unit, Reference Centre on Phylogeny, Molecular Epidemiology, and Microbial Evolution (FEMEM), National Institute of Health, 00161 Rome, Italy.
authors.forename: Alessandra
authors.initials: A
authors.lastname: Lo Presti
authors.affiliation: Department of Infectious, Parasitic, and Immune-Mediated Diseases, Epidemiology Unit, Reference Centre on Phylogeny, Molecular Epidemiology, and Microbial Evolution (FEMEM), National Institute of Health, 00161 Rome, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Ciccozzi
authors.affiliation: Clinical Pathology and Microbiology Laboratory, University Hospital Campus Bio-Medico of Rome, 00128 Rome, Italy.
authors.forename: Lucia
authors.initials: L
authors.lastname: De Florio
mesh_terms: D053607:Adrenomedullin / Q000097:blood*; D000368:Aged; D015415:Biomarkers / Q000097:blood; D002116:Calcitonin / Q000097:blood*; D015740:Calcitonin Gene-Related Peptide; D018932:Chemokine CCL2 / Q000097:blood*; D005260:Female; D006801:Humans; D015850:Interleukin-6 / Q000097:blood*; D008297:Male; D008875:Middle Aged; D011498:Protein Precursors / Q000097:blood*; D018805:Sepsis / Q000097:blood*; D014409:Tumor Necrosis Factor-alpha / Q000097:blood*
chemical_list: D015415:Biomarkers; C000606589:CALCA protein, human; C111835:CCL2 protein, human; D018932:Chemokine CCL2; D015850:Interleukin-6; D011498:Protein Precursors; D014409:Tumor Necrosis Factor-alpha; C088633:proadrenomedullin; D053607:Adrenomedullin; D002116:Calcitonin; D015740:Calcitonin Gene-Related Peptide