Biomarkers for the differentiation of sepsis and SIRS: the need for the standardisation of diagnostic studies

Hall, Thomas C.; Bilku, D.; Al-Leswas, D.; Horst, C.; Dennison, Ashley R.

doi:10.1007/s11845-011-0741-1

Cited by 15 publications

(13 citation statements)

References 50 publications

(30 reference statements)

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“…Most of those studies addressed the transcriptome or proteome for biomarker identifi cation (7)(8)(9). Even though 178 different biomarkers for sepsis have been proposed ( 7 ), most of them have only prognostic and not discriminative value.…”

mentioning

confidence: 99%

“…Even though 178 different biomarkers for sepsis have been proposed ( 7 ), most of them have only prognostic and not discriminative value. Only few have been suggested for differentiation of noninfectious induced SIRS from sepsis, and the majority have not been validated for clinical routine use ( 9 ). The only marker widely accepted in the clinical setting is procalcitonin.…”

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confidence: 99%

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Targeted metabolomics for discrimination of systemic inflammatory disorders in critically ill patients

Schmerler

Neugebauer

Ludewig

et al. 2012

Journal of Lipid Research

115

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confidence: 99%

mentioning

confidence: 99%

Targeted metabolomics for discrimination of systemic inflammatory disorders in critically ill patients

Schmerler

Neugebauer

Ludewig

et al. 2012

Journal of Lipid Research

115

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“…), a single specimen type (whole blood, plasma, and serum), and a single cutoff value in the absence of a single reference standard. From the existing literature, this goal also seems unlikely until some form of standardization or procedural norm is established for conducting future studies (2). Further, no single marker carries the necessary sensitivity, specificity, or positive or negative predictive value to stand on its own.…”

Section: Discussionmentioning

confidence: 99%

“…However, not all is lost. We are beginning to appreciate the hidden value buried in some of these biomarkers-e.g., using PCT to support antimicrobial stewardship, determining the duration of antimicrobial therapy, and ruling out rather than comfirming sepsis (2,3,10,13). In that sense, the use of transcriptome analysis to differentiate sepsis from SIRS and to predict patient risk for developing sepsis and organ failure seems to be a promising approach that could be developed over time into a nonbiased database of differential gene expression using standardized sequence-based and hybridization technologies.…”

Section: Discussionmentioning

confidence: 99%

“…A positive blood culture, for example, regardless of the organism's identity, is useful supplemental information but does not by itself indicate a septic state. In fact, the recovery of a potential pathogen from any site (1), including blood (2), occurs in less than 50% of all cases of sepsis, and contamination of blood cultures can cloud the interpretation. From the opposite direction, it is difficult to distinguish sepsis from systemic inflammatory response syndrome (SIRS) using clinical criteria alone (3).…”

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confidence: 99%

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Laboratory Diagnosis of Sepsis? No SIRS, Not Just Yet

Dunne

2015

J Clin Microbiol

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In order to maximize the benefit of prompt antimicrobial therapy and avoid the risk associated with inappropriate use of antimicrobial agents, patients with suspected sepsis must be rapidly differentiated from patients with systemic inflammatory response syndrome (SIRS). In combination with standard microbiological testing, a number of biomarkers have been recently evaluated for this purpose, and the performance characteristics of the most promising of these are reviewed.T he title of this minireview is somewhat misleading, because sepsis is not a laboratory diagnosis and cannot be defined (at least not yet) using any number of discrete diagnostic assays in the absence of clinical criteria. A positive blood culture, for example, regardless of the organism's identity, is useful supplemental information but does not by itself indicate a septic state. In fact, the recovery of a potential pathogen from any site (1), including blood (2), occurs in less than 50% of all cases of sepsis, and contamination of blood cultures can cloud the interpretation. From the opposite direction, it is difficult to distinguish sepsis from systemic inflammatory response syndrome (SIRS) using clinical criteria alone (3).A few definitions might help clarify the ambiguity here (4, 5). Some of these definitions have been refined over the years, but the general gist remains the same. "SIRS" was first defined in 1991 (4) and refers to "the systemic inflammatory response to a variety of severe clinical insults" (infectious or otherwise). It usually constitutes two or more of the following criteria: (i) temperature of Ͼ38°C or Ͻ36°C; (ii) heart rate of Ͼ90 beats/min; (iii) respiratory rate of Ͼ20 breaths/min or partial CO 2 pressure (pCO 2 ) of Ͻ32 mm Hg; (iv) white blood cell (WBC) count of Ͼ12,000 (12K)/l or Ͻ4K/l; or (v) Ͼ10% immature forms (i.e., bands). "Sepsis" has been defined as "the presence (probable or documented) of infection together with systemic manifestations of infection" (5). Having positive cultures supporting an infectious process adds credibility to the diagnosis but is not mandatory. Therefore, a patient can be classified as septic with Ն2 SIRS criteria and a clinical suspicion of infection without microbiological documentation. Bear this in mind when reading the remainder of this minireview. Most septic patients have SIRS, but not all SIRS patients are septic (Fig. 1). Severe sepsis adds an element of organ dysfunction or tissue hypoperfusion that is new and not explained by other causes of organ dysfunction (4). Finally, "septic shock" is "sepsis-induced hypotension persisting despite adequate fluid resuscitation" (4). Definitions specific for adult and pediatric populations are available (4-6).Sepsis is a major cause of morbidity and mortality among critically ill patients, and the management of septic shock profits from administration of early and appropriate antimicrobial therapy (7). Given that sepsis is only a subset of SIRS and that administration of antimicrobial therapy is not beneficial and indeed could generate...

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Fast differentiation of SIRS and sepsis from blood plasma of ICU patients using Raman spectroscopy

Neugebauer

Trenkmann

Bocklitz

et al. 2014

Journal of Biophotonics

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Currently, there is no biomarker that can reliable distinguish between infectious and non-infectious systemic inflammatory response syndrome (SIRS). However, such a biomarker would be of utmost importance for early identification and stratification of patients at risk to initiate timely and appropriate antibiotic treatment. Within this proof of principle study, the high potential of Raman spectroscopy for the fast differentiation of non-infectious SIRS and sepsis is demonstrated. Blood plasma collected from 70 patients from the intensive care unit (31 patients with sepsis and 39 patients classified with SIRS without infection) was analyzed by means of Raman spectroscopy. A PCA-LDA based classification model was trained with Raman spectra from test samples and yielded for sepsis a sensitivity of 1.0 and specificity of 0.82. These results have been confirmed with an independent dataset (prediction accuracy 80%).

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Biomarkers for the differentiation of sepsis and SIRS: the need for the standardisation of diagnostic studies

Cited by 15 publications

References 50 publications

Targeted metabolomics for discrimination of systemic inflammatory disorders in critically ill patients

Targeted metabolomics for discrimination of systemic inflammatory disorders in critically ill patients

Laboratory Diagnosis of Sepsis? No SIRS, Not Just Yet

Fast differentiation of SIRS and sepsis from blood plasma of ICU patients using Raman spectroscopy

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