Giuseppe Lippi¹, Martina Montagnana¹, Fiamma Balboni², Andrea Bellone³, Ivo Casagranda⁴, Mario Cavazza⁵, Giorgio Da Rin⁶, Daniele Coen³, Davide Giavarina⁷, Fabrizio Giostra⁸, Stefano Guzzetti⁹, Paola Pauri¹⁰, Rodolfo Sbrojavacca¹¹, Tommaso Trenti¹², Marcello Ciaccio¹³, Gianfranco Cervellin^14
1Sezione di Biochimica Clinica, Università degli Studi di Verona, Verona
²Laboratorio Analisi Chimico-Cliniche, Istituto Fiorentino di Cura e Assistenza, Firenze
³Pronto Soccorso e Medicina d’Urgenza, Grande Ospedale Metropolitano Niguarda, Milano
⁴Dipartimento di Emergenza ed Accettazione, Azienda Ospedaliera di Alessandria, Alessandria
⁵Pronto Soccorso, Ospedale S. Orsola-Malpighi, Università degli Studi di Bologna, Bologna
⁶Struttura Complessa di Medicina di Laboratorio, AULSS 7 Pedemontana, Bassano del Grappa (VI)
⁷Laboratorio di Chimica Clinica ed Ematologia, Ospedale “San Bortolo”, Vicenza
⁸Medicina e Chirurgia d’Accettazione e d’Urgenza, ASUR Marche, Area Vasta 4 Fermo, Fermo
⁹Pronto Soccorso, Ospedale L. Sacco, Milano
¹⁰Unità Operativa Complessa Patologia Clinica, Presidio Ospedaliero Carlo Urbani, Jesi
¹¹Pronto Soccorso e Medicina d’Urgenza, ASUI Udine, Udine
¹²Dipartimento di Medicina di Laboratorio e Anatomia Patologica, AUSL ed AOU di Modena, Modena
¹³Dipartimento di Biopatologia e Biotecnologie Mediche, Università degli Studi di Palermo, Palermo
¹⁴Pronto Soccorso e Medicina D’Urgenza, Azienda Ospedaliero-Universitaria di Parma, Parma

This article is drafted as a consensus document involving eight members of the Italian Society of Clinical Biochemistry and Laboratory Medicine (SIBioC) and eight members of the Academy of Emergency Medicine and Care (AcEMC), to whom a questionnaire was submitted for obtaining opinions on some recommendations about the use of biomarkers for diagnosing sepsis and managing antibiotic therapy in the emergency department. These recommendations were drafted following the National Guidelines Program (PNLG). According to the cumulative consent, three “A” recommendations (strongly recommended indication) emerged, which include biomarker availability (always available on prescription), clinical use (always interpreted in according to clinical data) and timing of the request based on half-life of the analyte. Recommendations of type “B” (indications carefully considered) included a general agreement about the clinical usefulness of sepsis biomarkers, the combination of procalcitonin (PCT) and Creactive protein (CRP), the possibility to be free on prescription to the laboratory, the use of cut-offs favoring a high negative predictive value, the use of more analytically sensitive assays and the possibility of using PCT for monitoring antibiotic therapy, with timing of ordering defined according to the metabolism of the analyte. As regards the specific biomarkers, a similar “B” consensus has been reached for measuring both PCT and CRP, and for measuring lactic acid. The measurement of other biomarkers is discouraged except for presepsin, for which there is still substantial uncertainty in favor or against.