Exclusion criteria were age less than 18 years old, incapability to give informed legal consent and evidence of a clearly different diagnosis.One www.selleckchem.com/products/Gemcitabine-Hydrochloride(Gemzar).html hundred six patients (43 females, 63 males) presented at the ED with suspected sepsis or septic shock and 83 more patients (30 females, 53 males) affected by SIRS were recruited as controls. In Table Table1,1, the demographic and clinical characteristics of the patients enrolled in the study are summarized. Clinical and biochemical data were recorded on admission. Blood samples were collected at the time of first medical evaluation (time 0, T0) in the ED before any medical treatment. Initial Sequential Organ Failure Assessment (SOFA) score  and Acute Physiology and Chronic Evaluation II (APACHE II) score  were calculated in the ED using clinical parameters and blood test results.
After the first evaluation in the ED, patients were admitted in intensive care areas (high-dependency unit, ICU or monitored medical ward). A few patients were later lost at follow-up; among the rest of them, blood specimens were collected after 24 hours (time 1, T1) and 72 hours (time 2, T2) to study the temporal trend of biomarkers. All the samples were stored at -70��C and thereafter analyzed blindly for sCD14-ST (presepsin) and PCT in the Clinical Chemistry Laboratory of Turin University Hospital. The definitive diagnosis (SIRS, sepsis, severe sepsis or septic shock) was made according to the criteria of the International Guidelines for Management of Severe Sepsis and Septic Shock [4,16] and afterwards obtained by clinicians by analysis of digital medical records (Table (Table2).
2). We evaluated survival on the basis of 60-day in-hospital mortality, and survival rates were then blindly matched to biomarker values obtained at the first evaluation in the ED.Table 1Demographic and clinical characteristics Brefeldin_A of the subjects in the study.aTable 2Definitive diagnosis and infective foci of patients included in the study.aMeasurement methodsBlood samples were collected in endotoxin-free tubes containing ethylenediaminetetraacetate (EDTA), centrifuged at 3,000 g for 10 min and then stored at -70��C until being assayed blindly for the presepsin and PCT measurements. Presepsin was dosed using the PATHFAST Immunoanalyzer system (Mitsubishi Chemical Europe GmbH, D��sseldorf, Germany), based on noncompetitive chemiluminescence enzyme immunoassay for the quantitative measurement of the biomarker concentration in anticoagulated (heparin or EDTA) whole blood or plasma.