Prognostic Value of Mid-Regional Proadrenomedullin Sampled at Presentation and after 72 Hours in Septic Patients Presenting to the Emergency Department: An Observational Two-Center Study
, Giorgia Montrucchio 3,4,†, Valeria Caramello 5, Francesca Rumbolo 6, Stefania Dutto 1,2, Sarah Boasso 1, Anita Ferraro 4, Luca Brazzi 3, Enrico Lupia 1,7, Adriana Boccuzzi 4, Giulio Mengozzi 6,7, Fulvio Morello 1,7,* and Stefania Battista 1
Round 1
Reviewer 1 Report
The authors are to be congratulated with a very good paper.
I have only tiny comments:
I suggest explaining the acronym LR in the legends to Table 2
I also suggest putting the definition of PCT in parenthesis after the acronym in the discussion.
Author Response
Reviewer 1
I suggest explaining the acronym LR in the legends to Table 2
I also suggest putting the definition of PCT in parenthesis after the acronym in the discussion.
Response to reviewer 1:
We made the changes accordingly.
Reviewer 2 Report
Is a study that must be confirmed by other research in the field.It would be interesting to know the costs of such a protocol with MR-proADM.
Author Response
Reviewer 2:
Is a study that must be confirmed by other research in the field.
It would be interesting to know the costs of such a protocol with MR-proADM.
Response to Reviewer 2:
The cost of serial sampling of MR-proADM is an interesting point. We added a comment about it in the Discussion (page 10 lines 36-37).
In our institutions a MR-proADM test costs around 22€, while a procalcitonin test costs around 11€. Therefore, measuring MR-proADM at arrival and after 72 hours would cost around 44€ and measuring procalcitonin every day would cost the same.
Reviewer 3 Report
In this observational two center study authors are evaluating the significance of mid-regional proadrenomedullin sampled at presentation and after 72 hours as a prognostic marker, in septic patients presenting to the Emergency Department. The study is well designed and manuscript is well written.
Following are some comments.
- This is a very nicely executed study design for easy read authors should provide a consort diagram of the study where they can depict the blinding, inclusion exclusion criteria, distribution and outcomes.
- Authors have tabulated a varieties of diseases which apparently lead to sepsis. A subgroup analysis is highly desirable between different groups of patients to dissect out the independent role of those occurrences on the level of MR proADM.
Author Response
Reviewer 3:
In this observational two center study authors are evaluating the significance of mid-regional proadrenomedullin sampled at presentation and after 72 hours as a prognostic marker, in septic patients presenting to the Emergency Department. The study is well designed and manuscript is well written.
Following are some comments.
- This is a very nicely executed study design for easy read authors should provide a consort diagram of the study where they can depict the blinding, inclusion exclusion criteria, distribution and outcomes.
- Authors have tabulated a varieties of diseases which apparently lead to sepsis. A subgroup analysis is highly desirable between different groups of patients to dissect out the independent role of those occurrences on the level of MR proADM.
Response to Revewer 3:
- We added a flow diagram depicting the study flow in Supplementary figure 1. We adapted the CONSORT flow diagram as it was designed for randomized-controlled trials.
- We added a subgroup analysis for the most common infective focus, which in our cohort was the lung (please see page 8 lines 14-22, page 9 lines 20-22, supplementary tables 3 and 6). We did not carried out further subgroup analysis given the small number of patients and events in those subgroups.
