Tommaso Fasano

Background: Monocyte Distribution Width (MDW) is a hematological parameter automatically generated during routine blood count analysis and currently represents the only blood count-derived biomarker for early sepsis risk assessment in adult emergency department (ED) patients. Evidence regarding its ability to identify blood culture (BC) positivity and bloodstream infection (BSI) remains limited. This cohort study aimed to evaluate its diagnostic accuracy. Methods: Adult patients presenting to the ED of a tertiary hospital with suspected infection and BC request were evaluated. Between March 2022 and December 2024, MDW, C-reactive protein (CRP), and BC results were retrospectively collected from the laboratory information system. Samples were categorized as BC-negative or BC-positive and further stratified into microbiological categories. Diagnostic performance was assessed using ROC curve analysis and decision curve analysis (DCA). Analyses were performed both including and excluding CoNS. Results: A total of 2,748 samples were available. MDW values were significantly higher in BC-positive than in BC-negative samples (25.8±6.7 vs. 23.4±4.7) and were highest in Gram-negative infections (27.7±7.5). When CoNS were excluded, MDW achieved an AUC of 0.65 at the optimal cut-off of 24.5, showing a sensitivity of 58% and specificity of 66.2%. Rule-out thresholds of 17.7 and 18.7 achieved sensitivities of 95% and 92.9%, respectively, whereas rule-in thresholds of 29.4 and 32 achieved specificities of 90.0% and 95.2%. MDW consistently outperformed CRP and demonstrated positive clinical net benefit in DCA. The addition of CRP did not provide improvement in diagnostic accuracy (AUC 0.65). Conclusions: MDW is associated with BC positivity and clinically significant BSI and outperforms CRP in identifying patients with BC-positive in the ED supporting its integration into diagnostic stewardship strategies and early risk stratification pathways.

Background/Objectives: Golgi protein 73 (GP73) is a transmembrane protein expressed by epithelial cells of the bile duct in the normal liver. High serum levels of GP73 have been detected in patients with acute or chronic liver diseases, MASLD, and its measurement has been suggested as a potential biomarker for liver fibrosis staging. We evaluated the utility of GP73 in the diagnosis of MASLD, MASH, and for liver fibrosis staging. Methods: We performed a literature scoping review to map the current evidence about the accuracy of GP73 in patients with MASLD. We searched in Medline and EMBASE for English studies reporting an AUC value of GP73 in diagnosing MASLD and MASH and evaluating GP73 for fibrosis staging. A narrative synthesis of the evidence was conducted. Moreover, we performed an observational study including 84 patients with MASLD, of which 60 were biopsy-confirmed MASH, and different liver fibrosis stages, and 15 healthy controls. Serum GP73 levels were determined using a chemiluminescent assay and reported as mean and standard deviation (SD). Sensitivity (SE), specificity (SP), the area under the receiver operating characteristic (AUROC) curve, and the optimal cut-off value were calculated. Data were considered statistically significant when p < 0.05. Results: Available studies evaluating GP73 in MASLD reported the ability to discriminate MASH from simple steatosis and distinguish patients at different fibrotic stages, but the evidence is still scarce. Our experimental study showed that the serum levels of GP73 were 30 ± 12 ng/mL in MASLD and 32 ± 12 ng/mL in MASH patients and were statistically higher than those of the control group (19 ± 30 ng/mL), increasing from liver fibrosis stage F0 to F4. GP73 levels were significantly higher in patients with significant and advanced fibrosis than controls and no significant fibrosis (p > 0.05). ROC analysis demonstrated that serum GP73 had a good diagnostic potential for MASLD (AUROC 0.85; SE 90%; SP 73%), MASH (AUROC 0.75; SE 82%; SP64%), and significant fibrosis (AUROC 0.7; SE 56%; SP 79%) and was better than other biomarkers for chronic liver diseases. Conclusions: Serum GP73 could support clinicians in the evaluation of patients with MASH and significant fibrosis.