Academy of Emergency Medicine and Care-Society of Clinical Biochemistry and Clinical Molecular Biology consensus recommendations for clinical use of sepsis biomarkers in the emergency department

  • Giuseppe Lippi Clinical Biochemistry Section, University of Verona, Verona, Italy.
  • Martina Montagnana Clinical Biochemistry Section, University of Verona, Verona, Italy.
  • Fiamma Balboni Clinical-Chemical Analysis Laboratory, Florentine Institute of Care and Assistance, Florence, Italy.
  • Andrea Bellone Emergency Medicine Department, Niguarda Hospital, Milan, Italy.
  • Ivo Casagranda Emergency Medicine Department, Hospital, Alessandria, Italy.
  • Mario Cavazza Emergency Medicine Department, S. Orsola-Malpighi Hospital- University of Bologna, Bologna, Italy.
  • Giorgio Da Rin Laboratory Medicine Unit, AULSS 7 Pedemontana, Bassano del Grappa (VI), Italy.
  • Daniele Coen Emergency Medicine Department, Niguarda Hospital, Milan, Italy.
  • Davide Giavarina Clinical Chemistry and Hematology Laboratory, “San Bortolo” Hospital, Vicenza, Italy.
  • Fabrizio Giostra Emergency Medicine Department, ASUR Marche, Fermo, Italy.
  • Stefano Guzzetti Emergency Medicine Department, L. Sacco Hospital, Milan, Italy.
  • Paola Pauri Clinical Pathology Unit/Analysis Laboratory, Carlo Urbani Hospital, Jesi, Italy.
  • Rodolfo Sbrojavacca Emergency Medicine Department, ASUI Udine, Udine, Italy.
  • Tommaso Trenti Laboratory Medicine and Pathological Anatomy Units, Modena Local Health Units, Modena, Italy.
  • Marcello Ciaccio Department of Biopathology and Medical Biotechnologies, University of Palermo, Palermo, Italy.
  • Gianfranco Cervellin | gcervellin@ao.pr.it Emergency Medicine Department, Academic Hospital of Parma, Parma, Italy.

Abstract

Increasing evidence is emerging that the measurement of circulating biomarkers may be clinically useful for diagnosing and monitoring sepsis. Eight members of AcEMC (Academy of Emergency Medicine and Care) and eight members of SIBioC (Italian Society of Clinical Biochemistry and Laboratory Medicine) were identified by the two scientific societies for producing a consensus document aimed to define practical recommendations about the use of biomarkers for diagnosing of sepsis and managing antibiotic therapy in the emergency department (ED). The cumulative opinions allowed defining three grade A recommendations (i.e., highly recommended indications), entailing ordering modality (biomarkers always available on prescription), practical use (results should be interpreted according to clinical information) and test ordering defined according to biomarker kinetics. Additional grade B recommendations (i.e., potentially valuable indications) entailed general agreement that biomarkers assessment may be of clinical value in the diagnostic approach of ED patients with suspected sepsis, suggestion for combined assessment of procalcitonin (PCT) and Creactive protein (CRP), free availability of the selected biomarker(s) on prescription, adoption of diagnostic threshold prioritizing high negative predictive value, preference for more analytically sensitive techniques, along with potential clinical usefulness of measuring PCT for monitoring antibiotic treatment, with serial testing defined according to biomarker kinetics. PCT and CRP were the two biomarkers that received the largest consensus as sepsis biomarkers (grade B recommendation), and a grade B recommendation was also reached for routine assessment of blood lactate. The assessment of biomarkers other than PCT and CRP was discouraged, with exception of presepsin for which substantial uncertainty in favor or against remained.

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Author Biography

Giuseppe Lippi, Clinical Biochemistry Section, University of Verona, Verona
Emergency Department
Published
2017-11-07
Info
Issue
Section
Opinion Reports
Keywords:
Sepsis, Biomarkers, Procalcitonin, C reactive Protein, Presepsin
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  • PDF: 599
How to Cite
Lippi, G., Montagnana, M., Balboni, F., Bellone, A., Casagranda, I., Cavazza, M., Da Rin, G., Coen, D., Giavarina, D., Giostra, F., Guzzetti, S., Pauri, P., Sbrojavacca, R., Trenti, T., Ciaccio, M., & Cervellin, G. (2017). Academy of Emergency Medicine and Care-Society of Clinical Biochemistry and Clinical Molecular Biology consensus recommendations for clinical use of sepsis biomarkers in the emergency department. Emergency Care Journal, 13(2). https://doi.org/10.4081/ecj.2017.6877