Biomarkers for the Prediction and Judgement of Sepsis and Sepsis Complications: A Step towards precision medicine?

Abstract

Sepsis and septic shock are a major public health concern and are still associated with high rates of morbidity and mortality. Whilst there is growing understanding of different phenotypes and endotypes of sepsis, all too often treatment strategies still only employ a “one-size-fits-all” approach. Biomarkers offer a unique opportunity to close this gap to more precise treatment approaches by providing insight into clinically hidden, yet complex, pathophysiology, or by individualizing treatment pathways. Predicting and evaluating systemic inflammation, sepsis or septic shock are essential to improve outcomes for these patients. Besides opportunities to improve patient care, employing biomarkers offers a unique opportunity to improve clinical research in patients with sepsis. The high rate of negative clinical trials in this field may partly be explained by a high degree of heterogeneity in patient cohorts and a lack of understanding of specific endotypes or phenotypes. Moving forward, biomarkers can support the selection of more homogeneous cohorts, thereby potentially improving study conditions of clinical trials. This may finally pave the way to a precision medicine approach to sepsis, septic shock and complication of sepsis in the future.

Biomarkers as Prognostic Predictors and Therapeutic Guide in Critically Ill Patients: Clinical Evidence

“…Biomarkers are the key to precision medicine because, within what is known as the omics sciences, they are the molecules currently available [ 3 ].…”

Enolase-1 as a Prognostic Biomarker of Sepsis

“…Apostolos Zarros 1,2,3* Sepsis is characterized by high morbidity and mortality and is part of a complex clinical continuum (along with systemic inflammation and septic shock) that is associated with the dysregulation of the systemic immune response to an infection. 1 As is the case with other inflammatory syndromes, sepsis is also characterized by a complex pathophysiology and usually affects patients with multiple comorbidities, thereby complicating sepsis-focused trials with significant heterogeneity. 1 In this respect, the identification of biomarkers has become of paramount importance for the early detection, the classification, the therapeutic guidance, the prediction or the detection of complications, and the prognosis of sepsis.…”

“…1 As is the case with other inflammatory syndromes, sepsis is also characterized by a complex pathophysiology and usually affects patients with multiple comorbidities, thereby complicating sepsis-focused trials with significant heterogeneity. 1 In this respect, the identification of biomarkers has become of paramount importance for the early detection, the classification, the therapeutic guidance, the prediction or the detection of complications, and the prognosis of sepsis. 1,2 Table 1 summarizes the most promising potential biomarkers of sepsis identified so far, as well as the nature of their function with regard to sepsis.…”

Impact of High-Density Lipoproteins on Sepsis

“…Rather than the inherent limitations of animal models, the more likely reason for poor clinical translation in the field of sepsis and the high rate of negative clinical trials is the high degree of heterogeneity in patient cohorts [ 130 ]. The classification of sepsis may be improved by the application of biological markers, which can potentiate the identification of distinct patient subclasses or endotypes [ 131 ].…”