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Azarsiz E, Karaca N, Kutukculer N. Mid-Regional Proadrenomedullin Levels in Primary Immunodeficiencies Complicated with Pulmonary Manifestations. Indian J Clin Biochem 2023; 38:475-484. [PMID: 37746537 PMCID: PMC10516846 DOI: 10.1007/s12291-022-01061-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 06/15/2022] [Indexed: 10/14/2022]
Abstract
The development of lower respiratory complications in children with primary immunodeficiencies characterized by recurrent infections significantly contributes to morbidity and mortality. This is clinically more important and specific in the evaluation of prognosis. The inflammatory response that develops throughout the clinical process can cause the release of several biomarkers. This study aimed to evaluate the inflammatory biomarker "mid-regional pro-adrenomedullin (MR-proADM)" levels by distribution of lower respiratory tract complications. Plasma MR-proADM levels were measured in children with (n = 52) and without (n = 103) lower respiratory tract complications. The complicated group was also evaluated as "infective and non-infective" groups. The median MR-proADM levels were higher in the complicated cases (p = 0.175). It was 205.5 (73.4- 562.6) ng/L in the infective group while it was 96.1 (26.1-43.3) ng/L in the non-infective group and the difference between the two groups was statistically significant (p = 0.003). The predictive value of MR-proADM (AUC = 0.749, p = 0.003) was statistically significant compared to CRP (AUC = 0.330, p = 0.040) and SAA (AUC = 0.261, p = 0.004) in the infective group. This study evidences that the MR-proADM levels are higher in PID cases with infective pulmonary complications. Among other markers, MR-proADM appears to be a particularly good predictive inflammation marker for these children. Supplementary Information The online version contains supplementary material available at 10.1007/s12291-022-01061-9.
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Affiliation(s)
- Elif Azarsiz
- Department of Clinical Biochemistry, Ege University Faculty of Medicine, 35040 Bornova- Izmir, Turkey
| | - Neslihan Karaca
- Department of Pediatric Immunology, Ege University Faculty of Medicine, Izmir, Turkey
| | - Necil Kutukculer
- Department of Pediatric Immunology, Ege University Faculty of Medicine, Izmir, Turkey
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2
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Baldirà J, Ruiz-Rodríguez JC, Ruiz-Sanmartin A, Chiscano L, Cortes A, Sistac DÁ, Ferrer-Costa R, Comas I, Villena Y, Larrosa MN, González-López JJ, Ferrer R. Use of Biomarkers to Improve 28-Day Mortality Stratification in Patients with Sepsis and SOFA ≤ 6. Biomedicines 2023; 11:2149. [PMID: 37626646 PMCID: PMC10452503 DOI: 10.3390/biomedicines11082149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 07/17/2023] [Accepted: 07/28/2023] [Indexed: 08/27/2023] Open
Abstract
Early diagnosis and appropriate treatments are crucial to reducing mortality risk in septic patients. Low SOFA scores and current biomarkers may not adequately discern patients that could develop severe organ dysfunction or have an elevated mortality risk. The aim of this prospective observational study was to evaluate the predictive value of the biomarkers mid-regional pro-adrenomedullin (MR-proADM), procalcitonin (PCT), C-reactive protein (CRP), and lactate for 28-day mortality in patients with sepsis, and patients with a SOFA score ≤6. 284 were included, with a 28-day all-cause mortality of 8.45% (n = 24). Non-survivors were older (p = 0.003), required mechanical ventilation (p = 0.04), were ventilated for longer (p = 0.02), and had higher APACHE II (p = 0.015) and SOFA (p = 0.027) scores. Lactate showed the highest predictive ability for all-cause 28-day mortality, with an area under the receiver-operating characteristic curve (AUROC) of 0.67 (0.55-0.79). The AUROC for all-cause 28-day mortality in patients with community-acquired infection was 0.69 (0.57-0.84) for SOFA and 0.70 (0.58-0.82) for MR-proADM. A 2.1 nmol/L cut-off point for this biomarker in this subgroup of patients discerned, with 100% sensibility, survivors from non-survivors at 28 days. In patients with community-acquired sepsis and initial SOFA score ≤ 6, MR-proADM could help identify patients at risk of 28-day mortality.
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Affiliation(s)
- Jaume Baldirà
- Intensive Care Department, Hospital de la Santa Creu i Sant Pau, 08041 Barcelona, Spain; (J.B.); (D.Á.S.)
- Department de Medicina, Universitat Autònoma de Barcelona, 08193 Barcelona, Spain (R.F.)
| | - Juan Carlos Ruiz-Rodríguez
- Department de Medicina, Universitat Autònoma de Barcelona, 08193 Barcelona, Spain (R.F.)
- Intensive Care Department, Hospital Universitari Vall d’Hebron, Campus Vall d’Hebron, 08035 Barcelona, Spain; (A.R.-S.); (A.C.)
- Shock, Organ Dysfunction and Resuscitation Research Group, Vall d’Hebron Institut de Recerca, Campus Vall d’Hebron, 08035 Barcelona, Spain
| | - Adolfo Ruiz-Sanmartin
- Intensive Care Department, Hospital Universitari Vall d’Hebron, Campus Vall d’Hebron, 08035 Barcelona, Spain; (A.R.-S.); (A.C.)
- Shock, Organ Dysfunction and Resuscitation Research Group, Vall d’Hebron Institut de Recerca, Campus Vall d’Hebron, 08035 Barcelona, Spain
| | - Luis Chiscano
- Department de Medicina, Universitat Autònoma de Barcelona, 08193 Barcelona, Spain (R.F.)
- Intensive Care Department, Hospital Universitari Vall d’Hebron, Campus Vall d’Hebron, 08035 Barcelona, Spain; (A.R.-S.); (A.C.)
- Shock, Organ Dysfunction and Resuscitation Research Group, Vall d’Hebron Institut de Recerca, Campus Vall d’Hebron, 08035 Barcelona, Spain
| | - Alejandro Cortes
- Intensive Care Department, Hospital Universitari Vall d’Hebron, Campus Vall d’Hebron, 08035 Barcelona, Spain; (A.R.-S.); (A.C.)
- Shock, Organ Dysfunction and Resuscitation Research Group, Vall d’Hebron Institut de Recerca, Campus Vall d’Hebron, 08035 Barcelona, Spain
| | - Diego Ángeles Sistac
- Intensive Care Department, Hospital de la Santa Creu i Sant Pau, 08041 Barcelona, Spain; (J.B.); (D.Á.S.)
| | - Roser Ferrer-Costa
- Clinical Laboratories, Clinical Biochemistry Department, Vall d’Hebron University Hospital, 08035 Barcelona, Spain; (R.F.-C.); (I.C.); (Y.V.)
| | - Inma Comas
- Clinical Laboratories, Clinical Biochemistry Department, Vall d’Hebron University Hospital, 08035 Barcelona, Spain; (R.F.-C.); (I.C.); (Y.V.)
| | - Yolanda Villena
- Clinical Laboratories, Clinical Biochemistry Department, Vall d’Hebron University Hospital, 08035 Barcelona, Spain; (R.F.-C.); (I.C.); (Y.V.)
| | - Maria Nieves Larrosa
- Microbiology Department, Vall d’Hebron University Hospital, 08035 Barcelona, Spain; (M.N.L.); (J.J.G.-L.)
- Microbiology Research Group, Vall d’Hebron Institut de Recerca (VHIR), Vall d’Hebron Barcelona Hospital Campus, 08035 Barcelona, Spain
- Department of Genetics and Microbiology, Universitat Autònoma de Barcelona, 08193 Bellaterra, Spain
- CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Juan José González-López
- Microbiology Department, Vall d’Hebron University Hospital, 08035 Barcelona, Spain; (M.N.L.); (J.J.G.-L.)
- Microbiology Research Group, Vall d’Hebron Institut de Recerca (VHIR), Vall d’Hebron Barcelona Hospital Campus, 08035 Barcelona, Spain
- Department of Genetics and Microbiology, Universitat Autònoma de Barcelona, 08193 Bellaterra, Spain
- CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Ricard Ferrer
- Department de Medicina, Universitat Autònoma de Barcelona, 08193 Barcelona, Spain (R.F.)
- Intensive Care Department, Hospital Universitari Vall d’Hebron, Campus Vall d’Hebron, 08035 Barcelona, Spain; (A.R.-S.); (A.C.)
- Shock, Organ Dysfunction and Resuscitation Research Group, Vall d’Hebron Institut de Recerca, Campus Vall d’Hebron, 08035 Barcelona, Spain
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3
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Corciulo C, Dal Pino B, Visentini D, Bigazzi F, Ripoli A, Sozio E, Curcio F, Tascini C, Fabris M, Sampietro T, Sbrana F. Lipid modification induced by lipoprotein apheresis could mirrored mid-regional-pro-adrenomedullin plasma levels? Transfus Apher Sci 2023; 62:103515. [PMID: 35927157 DOI: 10.1016/j.transci.2022.103515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 07/04/2022] [Accepted: 07/24/2022] [Indexed: 10/16/2022]
Affiliation(s)
- Carmen Corciulo
- Lipoapheresis Unit and Reference Center for Inherited Dyslipidemias, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Beatrice Dal Pino
- Lipoapheresis Unit and Reference Center for Inherited Dyslipidemias, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Daniela Visentini
- Istituto di Patologia Clinica, Azienda Sanitaria Universitaria Integrata di Udine (ASUID), Udine, Italy
| | - Federico Bigazzi
- Lipoapheresis Unit and Reference Center for Inherited Dyslipidemias, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Andrea Ripoli
- Lipoapheresis Unit and Reference Center for Inherited Dyslipidemias, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Emanuela Sozio
- U.O. Malattie Infettive, Dipartimento di Medicina dell'Università di Udine - Università di Udine e Azienda Sanitaria Universitaria Integrata di Udine, Udine, Italy
| | - Francesco Curcio
- Istituto di Patologia Clinica, Azienda Sanitaria Universitaria Integrata di Udine (ASUID), Udine, Italy
| | - Carlo Tascini
- U.O. Malattie Infettive, Dipartimento di Medicina dell'Università di Udine - Università di Udine e Azienda Sanitaria Universitaria Integrata di Udine, Udine, Italy
| | - Martina Fabris
- Istituto di Patologia Clinica, Azienda Sanitaria Universitaria Integrata di Udine (ASUID), Udine, Italy
| | - Tiziana Sampietro
- Lipoapheresis Unit and Reference Center for Inherited Dyslipidemias, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Francesco Sbrana
- Lipoapheresis Unit and Reference Center for Inherited Dyslipidemias, Fondazione Toscana Gabriele Monasterio, Pisa, Italy.
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Meijers WC, Bayes-Genis A, Mebazaa A, Bauersachs J, Cleland JGF, Coats AJS, Januzzi JL, Maisel AS, McDonald K, Mueller T, Richards AM, Seferovic P, Mueller C, de Boer RA. Circulating heart failure biomarkers beyond natriuretic peptides: review from the Biomarker Study Group of the Heart Failure Association (HFA), European Society of Cardiology (ESC). Eur J Heart Fail 2021; 23:1610-1632. [PMID: 34498368 PMCID: PMC9292239 DOI: 10.1002/ejhf.2346] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 08/13/2021] [Accepted: 09/07/2021] [Indexed: 12/18/2022] Open
Abstract
New biomarkers are being evaluated for their ability to advance the management of patients with heart failure. Despite a large pool of interesting candidate biomarkers, besides natriuretic peptides virtually none have succeeded in being applied into the clinical setting. In this review, we examine the most promising emerging candidates for clinical assessment and management of patients with heart failure. We discuss high-sensitivity cardiac troponins (Tn), procalcitonin, novel kidney markers, soluble suppression of tumorigenicity 2 (sST2), galectin-3, growth differentiation factor-15 (GDF-15), cluster of differentiation 146 (CD146), neprilysin, adrenomedullin (ADM), and also discuss proteomics and genetic-based risk scores. We focused on guidance and assistance with daily clinical care decision-making. For each biomarker, analytical considerations are discussed, as well as performance regarding diagnosis and prognosis. Furthermore, we discuss potential implementation in clinical algorithms and in ongoing clinical trials.
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Affiliation(s)
- Wouter C Meijers
- Department of Cardiology, University Medical Center Groningen, Groningen, The Netherlands
| | - Antoni Bayes-Genis
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, CIBERCV, Barcelona, Spain
| | - Alexandre Mebazaa
- Inserm U942-MASCOT; Université de Paris; Department of Anesthesia and Critical Care, Hôpitaux Saint Louis & Lariboisière; FHU PROMICE, Paris, France.,Université de Paris, Paris, France.,Department of Anesthesia and Critical Care, Hôpitaux Saint Louis & Lariboisière, Paris, France.,FHU PROMICE, Paris, France
| | - Johann Bauersachs
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - John G F Cleland
- Robertson Centre for Biostatistics and Clinical Trials, University of Glasgow; National Heart & Lung Institute, Imperial College London, London, UK
| | - Andrew J S Coats
- Monash University, Melbourne, Australia.,University of Warwick, Coventry, UK
| | | | | | | | - Thomas Mueller
- Department of Clinical Pathology, Hospital of Bolzano, Bolzano, Italy
| | - A Mark Richards
- Christchurch Heart Institute, Christchurch, New Zealand.,Cardiovascular Research Institute, National University of Singapore, Singapore
| | - Petar Seferovic
- Faculty of Medicine, Belgrade University, Belgrade, Serbia.,Serbian Academy of Sciences and Arts, Belgarde, Serbia
| | | | - Rudolf A de Boer
- Department of Cardiology, University Medical Center Groningen, Groningen, The Netherlands
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5
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Piccioni A, Saviano A, Cicchinelli S, Valletta F, Santoro MC, de Cunzo T, Zanza C, Longhitano Y, Tullo G, Tilli P, Candelli M, Covino M, Franceschi F. Proadrenomedullin in Sepsis and Septic Shock: A Role in the Emergency Department. Medicina (Kaunas) 2021; 57:medicina57090920. [PMID: 34577843 PMCID: PMC8472723 DOI: 10.3390/medicina57090920] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 08/27/2021] [Accepted: 08/28/2021] [Indexed: 02/05/2023]
Abstract
Sepsis and septic shock represent a leading cause of mortality in the Emergency Department (ED) and in the Intensive Care Unit (ICU). For these life-threating conditions, different diagnostic and prognostic biomarkers have been studied. Proadrenomedullin (MR-proADM) is a biomarker that can predict organ damage and the risk of imminent death in patients with septic shock, as shown by a large amount of data in the literature. The aim of our narrative review is to evaluate the role of MR-proADM in the context of Emergency Medicine and to summarize the current knowledge of MR-proADM as a serum indicator that is useful in the Emergency Department (ED) to determine an early diagnosis and to predict the long-term mortality of patients with sepsis and septic shock. We performed an electronic literature review to investigate the role of MR-proADM in sepsis and septic shock in the context of ED. We searched papers on PubMed®, Cochrane®, UptoDate®, and Web of Science® that had been published in the last 10 years. Data extracted from this literature review are not conclusive, but they show that MR-proADM may be helpful as a prognostic biomarker to stratify the mortality risk in cases of sepsis and septic shock with different degrees of organ damage, guiding emergency physicians in the diagnosis and the succeeding therapeutic workup. Sepsis and septic shock are conditions of high complexity and have a high risk of mortality. In the ED, early diagnosis is crucial in order to provide an early treatment and to improve patient survival. Diagnosis and prognosis are often the result of a combination of several tests. In our opinion, testing for MR-proADM directly in the ED could contribute to improving the prognostic assessment of patients, facilitating the subsequent clinical management and intensive treatment by the emergency physicians, but more studies are needed to confirm these results.
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Affiliation(s)
- Andrea Piccioni
- Emergency Department, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Roma, Italy; (A.P.); (S.C.); (F.V.); (M.C.S.); (T.d.C.); (C.Z.); (G.T.); (P.T.); (M.C.); (M.C.); (F.F.)
| | - Angela Saviano
- Emergency Department, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Roma, Italy; (A.P.); (S.C.); (F.V.); (M.C.S.); (T.d.C.); (C.Z.); (G.T.); (P.T.); (M.C.); (M.C.); (F.F.)
- Correspondence:
| | - Sara Cicchinelli
- Emergency Department, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Roma, Italy; (A.P.); (S.C.); (F.V.); (M.C.S.); (T.d.C.); (C.Z.); (G.T.); (P.T.); (M.C.); (M.C.); (F.F.)
| | - Federico Valletta
- Emergency Department, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Roma, Italy; (A.P.); (S.C.); (F.V.); (M.C.S.); (T.d.C.); (C.Z.); (G.T.); (P.T.); (M.C.); (M.C.); (F.F.)
| | - Michele Cosimo Santoro
- Emergency Department, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Roma, Italy; (A.P.); (S.C.); (F.V.); (M.C.S.); (T.d.C.); (C.Z.); (G.T.); (P.T.); (M.C.); (M.C.); (F.F.)
| | - Tommaso de Cunzo
- Emergency Department, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Roma, Italy; (A.P.); (S.C.); (F.V.); (M.C.S.); (T.d.C.); (C.Z.); (G.T.); (P.T.); (M.C.); (M.C.); (F.F.)
| | - Christian Zanza
- Emergency Department, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Roma, Italy; (A.P.); (S.C.); (F.V.); (M.C.S.); (T.d.C.); (C.Z.); (G.T.); (P.T.); (M.C.); (M.C.); (F.F.)
| | - Yaroslava Longhitano
- Dietetics and Clinical Nutrition Unit, Department of Internal Medicine, University of Genoa, IRCCS Polyclinic Hospital San Martino, 16132 Genoa, Italy;
| | - Gianluca Tullo
- Emergency Department, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Roma, Italy; (A.P.); (S.C.); (F.V.); (M.C.S.); (T.d.C.); (C.Z.); (G.T.); (P.T.); (M.C.); (M.C.); (F.F.)
| | - Pietro Tilli
- Emergency Department, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Roma, Italy; (A.P.); (S.C.); (F.V.); (M.C.S.); (T.d.C.); (C.Z.); (G.T.); (P.T.); (M.C.); (M.C.); (F.F.)
| | - Marcello Candelli
- Emergency Department, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Roma, Italy; (A.P.); (S.C.); (F.V.); (M.C.S.); (T.d.C.); (C.Z.); (G.T.); (P.T.); (M.C.); (M.C.); (F.F.)
| | - Marcello Covino
- Emergency Department, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Roma, Italy; (A.P.); (S.C.); (F.V.); (M.C.S.); (T.d.C.); (C.Z.); (G.T.); (P.T.); (M.C.); (M.C.); (F.F.)
| | - Francesco Franceschi
- Emergency Department, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Roma, Italy; (A.P.); (S.C.); (F.V.); (M.C.S.); (T.d.C.); (C.Z.); (G.T.); (P.T.); (M.C.); (M.C.); (F.F.)
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6
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Saeed K, Legramante JM, Angeletti S, Curcio F, Miguens I, Poole S, Tascini C, Sozio E, Del Castillo JG. Mid-regional pro-adrenomedullin as a supplementary tool to clinical parameters in cases of suspicion of infection in the emergency department. Expert Rev Mol Diagn 2021; 21:397-404. [PMID: 33736553 DOI: 10.1080/14737159.2021.1902312] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Mid-regional proadrenomedullin (MR-proADM), a novel biomarker, has recently gained interest particularly with regards to its potential in assisting clinicians' decision making in patients with suspicion of infection in the emergency department (ED). A group of international experts, with research and experience in MR-proADM applications, produced this review based on their own experience and the currently available literature. AREAS COVERED The review provides evidence related to MR-proADM as a triaging tool in avoiding unnecessary admissions to hospital and/or inadequate discharge, and identifying patients most at risk of deterioration. It also covers the use of MR-proADM in the context of COVID-19. Moreover, the authors provide a proposal on how to incorporate MR-proADM into patients' clinical pathways in an ED setting. EXPERT OPINION The data we have so far on the application of MR-proADM in the ED is promising. Incorporating it into clinical scoring systems may aid the clinician's decision making and recognizing the 'ill looking well' and the 'well looking ill' sooner. However there are still many gaps in our knowledge especially during the ongoing COVID-19 waves. There is also a need for cost-effectiveness analysis studies especially in the era of increasing cost pressures on health systems globally.
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Affiliation(s)
- Kordo Saeed
- Microbiology Innovation and Research UNIT, Department of Infection, University Hospitals Southampton NHS Foundation Trust, Southampton, UK.,School of Medicine, University of Southampton, Southampton, UK
| | | | - Silvia Angeletti
- Clinical Pathology, University Hospital Campus Bio-Medico of Rome Science Unit, University Campus Bio-Medico of Rome, Faculty of Medicine University Campus Bio-Medico of Rome, Italy
| | - Francesco Curcio
- Department of Medicine (DAME), University of Udine, Udine, Italy
| | - Iria Miguens
- Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Stephen Poole
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Carlo Tascini
- Infectious Diseases Clinic, Udine University Hospital, Udine, Italy
| | - Emanuela Sozio
- Infectious Diseases Clinic, Udine University Hospital, Udine, Italy
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7
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Leong K, Gaglani B, Khanna AK, McCurdy MT. Novel Diagnostics and Therapeutics in Sepsis. Biomedicines 2021; 9:biomedicines9030311. [PMID: 33803628 PMCID: PMC8003067 DOI: 10.3390/biomedicines9030311] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 03/13/2021] [Accepted: 03/16/2021] [Indexed: 12/11/2022] Open
Abstract
Sepsis management demands early diagnosis and timely treatment that includes source control, antimicrobial therapy, and resuscitation. Currently employed diagnostic tools are ill-equipped to rapidly diagnose sepsis and isolate the offending pathogen, which limits the ability to offer targeted and lowest-toxicity treatment. Cutting edge diagnostics and therapeutics in development may improve time to diagnosis and address two broad management principles: (1) source control by removing the molecular infectious stimulus of sepsis, and (2) attenuation of the pathological immune response allowing the body to heal. This review addresses novel diagnostics and therapeutics and their role in the management of sepsis.
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Affiliation(s)
- Kieran Leong
- Division of Pulmonary & Critical Care, University of Maryland School of Medicine, Baltimore, MD 21201, USA;
| | - Bhavita Gaglani
- Department of Anesthesiology, Section on Critical Care Medicine, Wake Forest University Hospital, Winston-Salem, NC 27157, USA; (B.G.); (A.K.K.)
| | - Ashish K. Khanna
- Department of Anesthesiology, Section on Critical Care Medicine, Wake Forest University Hospital, Winston-Salem, NC 27157, USA; (B.G.); (A.K.K.)
- Department of Outcomes Research, Outcomes Research Consortium, Cleveland, OH 44195, USA
| | - Michael T. McCurdy
- Division of Pulmonary & Critical Care, University of Maryland School of Medicine, Baltimore, MD 21201, USA;
- Correspondence:
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8
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Spoto S, Agrò FE, Sambuco F, Travaglino F, Valeriani E, Fogolari M, Mangiacapra F, Costantino S, Ciccozzi M, Angeletti S. High value of mid-regional proadrenomedullin in COVID-19: A marker of widespread endothelial damage, disease severity, and mortality. J Med Virol 2021; 93:2820-2827. [PMID: 33200824 PMCID: PMC7753433 DOI: 10.1002/jmv.26676] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 10/14/2020] [Accepted: 11/13/2020] [Indexed: 01/06/2023]
Abstract
The widespread endothelial damage due to severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) may lead to a disruption of the adrenomedullin (ADM) system responsible for vascular leakage, increased inflammatory status, and microvascular alteration with multi‐organs dysfunction. The aim of this study was to evaluate the role of mid‐regional proadrenomedullin (MR‐proADM) as a marker of SARS‐CoV2 related widespread endothelial damage, clinically identified by organs damage, disease severity and mortality. Patients with SARS‐CoV‐2 infection has been prospectively enrolled and demographic characteristic, clinical and laboratory data has been evaluated. In the overall population, 58% developed acute respiratory distress syndrome (ARDS), 23.3% of patients died, 6.5% acute cardiac injury, 1.4% of patients developed acute ischemic stroke, 21.2% acute kidney injury, 11.8% acute liver damage, and 5.4% septic shock. The best MR‐proADM cut‐off values for ARDS development and mortality prediction were 3.04 and 2 nmol/L, respectively. Patients presenting with MR‐proADM values ≥2 nmol/L showed a significantly higher mortality risk. In conclusion, MR‐proADM values ≥2 nmol/L identify those patients with high mortality risk related to a multiorgan dysfunction syndrome. These patients must be carefully evaluated and considered for an intensive therapeutic approach.
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Affiliation(s)
- Silvia Spoto
- Diagnostic and Therapeutic Medicine Department, University Campus Bio-Medico of Rome, Rome, Italy
| | - Felice E Agrò
- Intensive Care and Pain Management, Department of Anesthesia, University Campus Bio-Medico of Rome, Rome, Italy
| | - Federica Sambuco
- Emergency Department, University Campus Bio-Medico of Rome, Rome, Italy
| | | | - Emanuele Valeriani
- Diagnostic and Therapeutic Medicine Department, University Campus Bio-Medico of Rome, Rome, Italy
| | - Marta Fogolari
- Unit of Clinical Laboratory Science, University Campus Bio-Medico of Rome, Rome, Italy
| | - Fabio Mangiacapra
- Unit of Cardiovascular Science, University Campus Bio-Medico of Rome, Rome, Italy
| | - Sebastiano Costantino
- Diagnostic and Therapeutic Medicine Department, University Campus Bio-Medico of Rome, Rome, Italy
| | - Massimo Ciccozzi
- Unit of Medical Statistics and Molecular Epidemiology, University Campus Bio-Medico of Rome, Rome, Italy
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9
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Zampino R, Iossa D, Ursi MP, Bertolino L, Andini R, Molaro R, Fabrazzo O, Leonardi S, Atripaldi L, Durante-Mangoni E. Prognostic value of pro-adrenomedullin and copeptin in acute infective endocarditis. BMC Infect Dis 2021; 21:23. [PMID: 33413127 PMCID: PMC7791699 DOI: 10.1186/s12879-020-05655-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 11/24/2020] [Indexed: 11/26/2022] Open
Abstract
Background Infective endocarditis (IE) is a life-threatening disease whose prognosis is often difficult to predict based on clinical data. Biomarkers have been shown to favorably affect disease management in a number of cardiac disorders. Aims of this retrospective study were to assess the prognostic role of procalcitonin (PCT), pro-adrenomedullin (pro-ADM) and copeptin in IE and their relation with disease characteristics and the traditional biomarker C-reactive protein (CRP). Methods We studied 196 patients with definite IE. Clinical, laboratory and echocardiography parameters were analyzed, with a focus on co-morbidities. PCT, pro-ADM and copeptin were measured on stored plasma samples obtained on admission during the acute phase of the disease. Results Pro-ADM and copeptin were significantly higher in older patients and associated with prior chronic kidney disease. Pro-ADM was an independent predictor of hospital mortality (OR 3.29 [95%C.I. 1.04–11.5]; p = 0.042) whilst copeptin independently predicted 1-year mortality (OR 2.55 [95%C.I. 1.18–5.54]; p = 0.017). A high PCT value was strictly tied with S. aureus etiology (p = 0.001). CRP was the only biomarker associated with embolic events (p = 0.003). Conclusions Different biomarkers correlate with distinct IE outcomes. Pro-ADM and copeptin may signal a worse prognosis of IE on admission to the hospital and could be used to identify patients who need more aggressive treatment. CRP remains a low-cost marker of embolic risk. A high PCT value should suggest S. aureus etiology. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-020-05655-7.
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Affiliation(s)
- Rosa Zampino
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy.,Unit of Infectious & Transplant Medicine, A.O.R.N. Ospedali dei Colli - Ospedale Monaldi, Naples, Italy
| | - Domenico Iossa
- Department of Precision Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Maria Paola Ursi
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Lorenzo Bertolino
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Roberto Andini
- Unit of Infectious & Transplant Medicine, A.O.R.N. Ospedali dei Colli - Ospedale Monaldi, Naples, Italy
| | - Rosa Molaro
- Department of Precision Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Oriana Fabrazzo
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Silvia Leonardi
- Unit of Clinical Biochemistry, A.O.R.N. Ospedali dei Colli - Ospedale Monaldi, Naples, Italy
| | - Luigi Atripaldi
- Unit of Clinical Biochemistry, A.O.R.N. Ospedali dei Colli - Ospedale Monaldi, Naples, Italy
| | - Emanuele Durante-Mangoni
- Unit of Infectious & Transplant Medicine, A.O.R.N. Ospedali dei Colli - Ospedale Monaldi, Naples, Italy. .,Department of Precision Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy.
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10
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Spoto S, Nobile E, Carnà EPR, Fogolari M, Caputo D, De Florio L, Valeriani E, Benvenuto D, Costantino S, Ciccozzi M, Angeletti S. Best diagnostic accuracy of sepsis combining SIRS criteria or qSOFA score with Procalcitonin and Mid-Regional pro-Adrenomedullin outside ICU. Sci Rep 2020; 10:16605. [PMID: 33024218 PMCID: PMC7538435 DOI: 10.1038/s41598-020-73676-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 09/03/2020] [Indexed: 12/17/2022] Open
Abstract
Early diagnosis and treatment significantly reduce sepsis mortality. Currently, no gold standard has been yet established to diagnose sepsis outside the ICU. The aim of the study was to evaluate the diagnostic accuracy of sepsis defined by SIRS Criteria of 1991, Second Consensus Conference Criteria of 2001, modified Second Consensus Conference Criteria of 2001 (obtaining SIRS Criteria and SOFA score), Third Consensus Conference of 2016, in addition to the dosage of Procalcitonin (PCT) and MR-pro-Adrenomedullin (MR-proADM). In this prospective study, 209 consecutive patients with clinical diagnosis of sepsis were enrolled (May 2014-June 2018) outside intensive care unit (ICU) setting. A diagnostic protocol could include SIRS criteria or qSOFA score evaluation, rapid testing of PCT and MR-proADM, and SOFA score calculation for organ failure definition. Using this approach outside the ICU, a rapid diagnostic and prognostic evaluation could be achieved, also in the case of negative SIRS, qSOFA or SOFA scores with high post-test probability to reduce mortality and improve outcomes.
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Affiliation(s)
- Silvia Spoto
- Diagnostic and Therapeutic Medicine Department, University Campus Bio-Medico, Via Alvaro del Portillo 200, 00128, Rome, Italy.
| | - Edoardo Nobile
- Diagnostic and Therapeutic Medicine Department, University Campus Bio-Medico, Via Alvaro del Portillo 200, 00128, Rome, Italy
| | - Emanuele Paolo Rafano Carnà
- Diagnostic and Therapeutic Medicine Department, University Campus Bio-Medico, Via Alvaro del Portillo 200, 00128, Rome, Italy
| | - Marta Fogolari
- Unit of Clinical Laboratory Science, University Campus Bio-Medico, Rome, Italy
| | - Damiano Caputo
- Department of Surgery, University Campus Bio-Medico, Rome, Italy
| | - Lucia De Florio
- Unit of Clinical Laboratory Science, University Campus Bio-Medico, Rome, Italy
| | - Emanuele Valeriani
- Diagnostic and Therapeutic Medicine Department, University Campus Bio-Medico, Via Alvaro del Portillo 200, 00128, Rome, Italy
| | - Domenico Benvenuto
- Unit of Medical Statistics and Molecular Epidemiology, University Campus Bio-Medico, Rome, Italy
| | - Sebastiano Costantino
- Diagnostic and Therapeutic Medicine Department, University Campus Bio-Medico, Via Alvaro del Portillo 200, 00128, Rome, Italy
| | - Massimo Ciccozzi
- Unit of Medical Statistics and Molecular Epidemiology, University Campus Bio-Medico, Rome, Italy
| | - Silvia Angeletti
- Unit of Clinical Laboratory Science, University Campus Bio-Medico, Rome, Italy
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11
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Abstract
Sepsis and pneumonia cause significant morbidity and mortality worldwide. Despite improvements in diagnostic methodologies for organism identification, the early recognition and further risk stratification of these infections can be challenging. Although traditional clinical scoring systems are beneficial for the management of sepsis and pneumonia, biomarkers supporting the diagnosis and management of these infectious diseases are needed. Many biomarkers have been identified and there is no lack of studies and meta-analyses assessing the utility of biomarkers. Focusing primarily on sepsis and pneumonia, this article discusses the most commonly used biomarkers for which clinical laboratory testing methods are available.
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Affiliation(s)
- Stefan Riedel
- Department of Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Yamins 309, Boston, MA 02215, USA.
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12
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Abstract
Sepsis is a dysregulated systemic reaction to a common infection, that can cause life-threatening organ dysfunction. Over the last decade, the mortality rate of patients with sepsis has decreased as long as patients are treated according to the recommendations of the Surviving Sepsis Campaign, but is still unacceptably high. Patients at risk of sepsis should therefore be identified prior to the onset of organ dysfunction and this requires a rapid diagnosis and a prompt initiation of treatment. Unfortunately, there is no gold standard for the diagnosis of sepsis and traditional standard culture methods are time-consuming. Recently, in order to overcome these limitations, biomarkers which could help in predicting the diagnosis and prognosis of sepsis, as well as being useful for monitoring the response to treatments, have been identified. In addition, recent advances have led to the development of newly identified classes of biomarkers such as microRNAs, long-non-coding RNAs, and the human microbiome. This review focuses on the latest information on biomarkers that can be used to predict the diagnosis and prognosis of sepsis.
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Affiliation(s)
- Mi Hee Kim
- Division of Infectious Disease, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jung Hyun Choi
- Division of Infectious Disease, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea.
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13
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Spoto S, Fogolari M, De Florio L, Minieri M, Vicino G, Legramante J, Lia MS, Terrinoni A, Caputo D, Costantino S, Bernardini S, Ciccozzi M, Angeletti S. Procalcitonin and MR-proAdrenomedullin combination in the etiological diagnosis and prognosis of sepsis and septic shock. Microb Pathog 2019; 137:103763. [DOI: 10.1016/j.micpath.2019.103763] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 09/24/2019] [Accepted: 09/25/2019] [Indexed: 10/25/2022]
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14
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Gonzalez Del Castillo J, Wilson DC, Clemente-Callejo C, Román F, Bardés-Robles I, Jiménez I, Orviz E, Dastis-Arias M, Espinosa B, Tornero-Romero F, Giol-Amich J, González V, Llopis-Roca F. Biomarkers and clinical scores to identify patient populations at risk of delayed antibiotic administration or intensive care admission. Crit Care 2019; 23:335. [PMID: 31665092 PMCID: PMC6819475 DOI: 10.1186/s13054-019-2613-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 09/13/2019] [Indexed: 12/29/2022]
Abstract
BACKGROUND The performance of blood biomarkers (mid-regional proadrenomedullin (MR-proADM), procalcitonin (PCT), C-reactive protein (CRP), and lactate) and clinical scores (Sequential Organ Failure Assessment (SOFA), National Early Warning Score (NEWS), and quick SOFA) was compared to identify patient populations at risk of delayed treatment initiation and disease progression after presenting to the emergency department (ED) with a suspected infection. METHODS A prospective observational study across three EDs. Biomarker and clinical score values were calculated upon presentation and 72 h, and logistic and Cox regression used to assess the strength of association. Primary outcomes comprised of 28-day mortality prediction and delayed antibiotic administration or intensive care (ICU) admission, whilst secondary outcomes identified subsequent disease progression. RESULTS Six hundred eighty-four patients were enrolled with hospitalisation, ICU admission, and infection-related 28-day mortality rates of 72.8%, 3.4%, and 4.4%, respectively. MR-proADM and NEWS had the strongest association with hospitalisation and the requirement for antibiotic administration, whereas MR-proADM alone had the strongest association with ICU admission (OR [95% CI]: 5.8 [3.1 - 10.8]) and mortality (HR [95% CI]: 3.8 [2.2 - 6.5]). Patient subgroups with high MR-proADM concentrations (≥ 1.77 nmol/L) and low NEWS (< 5 points) values had significantly higher rates of ICU admission (8.1% vs 1.6%; p < 0.001), hospital readmission (18.9% vs. 5.9%; p < 0.001), infection-related mortality (13.5% vs. 0.2%; p < 0.001), and disease progression (29.7% vs. 4.9%; p < 0.001) than corresponding patients with low MR-proADM concentrations. ICU admission was delayed by 1.5 [0.25 - 5.0] days in patients with high MR-proADM and low NEWS values compared to corresponding patients with high NEWS values, despite similar 28-day mortality rates (13.5% vs. 16.5%). Antibiotics were withheld in 17.4% of patients with high MR-proADM and low NEWS values, with higher subsequent rates of ICU admission (27.3% vs. 4.8%) and infection-related hospital readmission (54.5% vs. 14.3%) compared to those administered antibiotics during ED treatment. CONCLUSIONS Patients with low severity signs of infection but high MR-proADM concentrations had an increased likelihood of subsequent disease progression, delayed antibiotic administration or ICU admission. Appropriate triage decisions and the rapid use of antibiotics in patients with high MR-proADM concentrations may constitute initial steps in escalating or intensifying early treatment strategies.
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Affiliation(s)
- Juan Gonzalez Del Castillo
- Emergency Department, Hospital Clínico San Carlos, Madrid, Spain.,San Carlos Clinical Research Institute Hospital San Carlos (IdISSC), Madrid, Spain
| | - Darius Cameron Wilson
- Shock, Organ Dysfunction and Resuscitation Research Group, Vall d'Hebron Institute of Research, Barcelona, Spain.
| | | | - Francisco Román
- Emergency Department, Short Stay Unit and Home Hospitalization Unit, Hospital General de Alicante, Alicante, Spain
| | | | - Inmaculada Jiménez
- Emergency Department, Short Stay Unit and Home Hospitalization Unit, Hospital General de Alicante, Alicante, Spain
| | - Eva Orviz
- Internal Medicine Department, Hospital Clínico San Carlos, Madrid, Spain
| | - Macarena Dastis-Arias
- Clinical Laboratory Department, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - Begoña Espinosa
- Emergency Department, Short Stay Unit and Home Hospitalization Unit, Hospital General de Alicante, Alicante, Spain
| | | | - Jordi Giol-Amich
- Emergency Department, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - Veronica González
- Emergency Department, Short Stay Unit and Home Hospitalization Unit, Hospital General de Alicante, Alicante, Spain
| | - Ferran Llopis-Roca
- Emergency Department, Hospital Universitari de Bellvitge, Barcelona, Spain
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15
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Mangioni D, Viaggi B, Giani T, Arena F, D'Arienzo S, Forni S, Tulli G, Rossolini GM. Diagnostic stewardship for sepsis: the need for risk stratification to triage patients for fast microbiology workflows. Future Microbiol 2019; 14:169-174. [PMID: 30628478 DOI: 10.2217/fmb-2018-0329] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Affiliation(s)
- Davide Mangioni
- Department of Infectious and Tropical Diseases, ASST Spedali Civili General Hospital - University of Brescia, Brescia, Italy.,Infectious Diseases Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico - University of Milan, Milan, Italy
| | - Bruno Viaggi
- Department of Anesthesiology, Neuro Intensive Care Unit, Florence Careggi University Hospital, Florence, Italy
| | - Tommaso Giani
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.,Clinical Microbiology and Virology Unit, Florence Careggi University Hospital, Florence, Italy
| | - Fabio Arena
- Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | | | | | | | - Gian M Rossolini
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.,Clinical Microbiology and Virology Unit, Florence Careggi University Hospital, Florence, Italy
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