Background and Objectives: Sepsis is a life-threatening condition characterized by organ dysfunction due to a dysregulated host response to infection. Blood cultures (BCs) remain the gold standard for diagnosing bloodstream infections, yet their positivity rate is limited and culture-negative sepsis remains poorly characterized. This study aimed to identify clinical and laboratory predictors of BC positivity in patients with suspected sepsis and to evaluate the prognostic implications of BC results on 28-, 90-, and 365-day survival. Materials and Methods: We retrospectively analyzed adult patients admitted to the Emergency Department of Policlinico di Bari (March 2023–December 2025) with sepsis or septic shock (Sepsis-3 criteria). After excluding contaminated cultures, 912 patients were included (602 culture-positive; 310 culture-negative) with a 1-year follow up. Predictors of BC positivity were assessed using logistic regression and ROC analysis; survival was evaluated with Kaplan–Meier curves and Cox models adjusted for age and Sequential Organ Failure Assessment (SOFA) score. We also evaluated time-to-positivity (TTP) for all blood culture isolates. Results: Culture-positive patients presented with greater initial severity, including higher rates of septic shock, elevated procalcitonin, CRP, lactate, and SOFA scores, and more frequent thrombocytopenia. Procalcitonin showed good discriminatory ability (AUC (area under the ROC curve) 0.785; cutoff 0.85 ng/mL; sensitivity 59.8%; specificity 83.8%). Key laboratory thresholds included a procalcitonin cutoff of 0.85 ng/mL, while CRP and platelet count did not show meaningful discriminatory cutoffs beyond their significant differences between culture-positive and culture-negative patients. Survival was consistently lower in culture-positive patients at 28 days (72.9% vs. 85.9%), 90 days (57.5% vs. 71.8%), and 365 days (44.3% vs. 61.2%). However, in adjusted Cox regression, BC positivity was not independently associated with 1-year mortality (HR 1.46; p = 0.092), whereas age and SOFA score remained significant predictors. Conclusions: Blood culture positivity identifies patients with greater initial severity, explaining their poorer unadjusted survival. However, culture positivity itself is not an independent predictor of long-term mortality, as age and organ dysfunction remain the main determinants of outcome. Procalcitonin showed solid discriminatory ability for true bacteremia.

Background: It is estimated that most patients with severe sepsis are admitted through the emergency department. Early identification and subsequent early appropriate therapy remain cornerstones of sepsis management. Early recognition of sepsis in the emergency department (ED) is crucial. The National Early Warning Score 2 (NEWS2) has shown limitations in prognostic accuracy. We aimed to develop and evaluate a prognostic model combining NEWS2 with triage data to predict 28- and 90-day mortality in adult patients with bacterial sepsis. Methods: We conducted a retrospective cohort study of 557 patients admitted to the ED with suspected bacterial infection between March 2017 and September 2019. Candidate predictors included triage variables (vital signs, comorbidities, blood gas data) and clinical scores (NEWS2, SOFA, qSOFA, APACHE2, and SIRS). Outcomes were 28- and 90-day mortality. Logit analysis was used to develop prognostic models, with assessment of discrimination and calibration. Results: Overall mortality was 24.6% at 28 days and 36.4% at 90 days. Models combining NEWS2, age, and lactates outperformed NEWS2 alone (28-day: 73.8% vs. 69%; 90-day: 71.6% vs. 67%). Including terminal status further improved accuracy. Finally, this paper proposes new criteria for the early identification of patients with sepsis in triage, with positive outcomes. Conclusions: Combining NEWS2 with age and lactates enhances prognostic accuracy at triage. This model may inform improved sepsis management.

Background and Aim: The correct identification of patients presenting with chest pain and the stratification of their risk for major adverse cardiovascular events (MACE) is essential. The aim of this study was to evaluate subjects who came to the ED for chest pain through the chest pain score, the HEART score and the TIMI risk score in order to assess their validity and prognostic accuracy and to compare their performance. Methods: Patients included in the study met the following criteria: age ≥18 years, reported atraumatic chest pain, and consent to participate in the clinical study. Subsequently, the final scores were calculated based on the information collected and a follow-up was performed to assess the occurrence of adverse cardiovascular events (MACEs) at 30 days. The MACEs considered were a composite endpoint of STEMI or NSTEMI myocardial infarction, positive coronary angiography for critical lesions, percutaneous coronary angioplasty, coronary artery bypass grafting, and death. Results: A total of 102 patients were included in the study sample, divided into 76 patients who did not develop MACEs and 26 patients who experienced MACEs. The AUC values of the ROC curves of the chest pain score, HEART score and TIMI risk score were 0.8312, 0.9757 and 0.9378 respectively. Conclusions: All three scores examined were considered excellent tools to predict the onset of MACEs in patients with chest pain at different points of clinical management, although the HEART score outperformed both the chest pain score and the TIMI risk score in terms of prognostic accuracy.

Background: Sepsis is a complex, heterogeneous syndrome involving dysregulated inflammatory, haematopoietic, and coagulation pathways that collectively drive organ dysfunction. Evaluating a multi-pathway biomarker panel may provide a more comprehensive characterization of clinical severity. Methods: This retrospective, single-centre study included 228 adult patients with suspected sepsis evaluated at emergency department admission and categorized by SOFA score into High Risk (HR, SOFA ≥ 13; n = 78), Severe Risk (SR, SOFA 10–12; n = 52), Moderate Risk (MR, SOFA 7–9; n = 58), and Low Risk (LR, SOFA 0–6; n = 40). We assessed procalcitonin (PCT), presepsin (P-SEP), C-reactive protein (CRP), white blood cell count (WBC), immature granulocyte (IG%), platelet count (PLT), immature platelet fractions (IPF%, IPF#), and D-dimer (DD). Results: Blood cultures were positive in 65.4% of patients. PLT count and DD demonstrated the highest discriminative performance for distinguishing combined HR + SR from MR + LR groups, with areas under the ROC curve (AUCs) of 0.902 and 0.894, respectively. Among inflammatory markers, PCT achieved the highest AUC (0.835), followed by P-SEP (0.793) and CRP (0.726). WBC showed limited discrimination (0.582); immature lineage markers showed higher numerical discrimination, with both IG% and relative IPF% achieving AUCs of 0.796. Conclusions: Relative IPF% increased in parallel with severe thrombocytopenia in higher-SOFA groups, a pattern compatible with compensatory thrombopoietic activity, whereas absolute IPF# declined in HR cases. These findings highlight distinct multi-organ biomarker profiles across severity states and support an integrated biomarker framework, a multi-pathway approach incorporating bone marrow kinetics and coagulation markers to refine early severity characterization in emergency settings.