Sepsis biomarkers

Abstract

Sepsis is the most frequent cause of death in non-coronary intensive care units (ICUs). In the past 10 years, progress has been made in the early identification of septic patients and in their treatment and these improvements in support and therapy mean that the mortality is gradually decreasing but it still remains unacceptably high. Leaving clinical diagnosis aside, the laboratory diagnostics represent a complex range of investigations that can place significant demands on the system given the speed of response required. There are hundreds of biomarkers which could be potentially used for diagnosis and prognosis in septic patients. The main attributes of successful markers would be high sensitivity, specificity, possibility of bed-side monitoring, and financial accessibility. Only a fraction is used in routine clinical practice because many lack sufficient sensitivity or specificity. The following review gives a short overview of the current epidemiology of sepsis, its pathogenesis and state-of-the-art knowledge on the use of specific biochemical, hematological and immunological parameters in its diagnostics. Prospective approaches towards discovery of new diagnostic biomarkers have been shortly mentioned.

Presentation and diagnosis of adult-onset Still’s disease: the implications of current and emerging markers in overcoming the diagnostic challenge

“…This item is also included in the diagnostic criteria of sepsis [39]. Lipopolysaccharide-binding protein, a molecule produced by the liver as part of the acute-phase inflammatory response, is another useful marker for differential diagnosis [40]. CD64, a high-affinity receptor for IgG expressed on neutrophils, and sCD14-ST (named presepsin), a receptor for complexes lipopolysaccharide-binding protein located on the surface of monocytes/macrophages, have been considered.…”

Evaluation of thrombomodulin and pentraxin-3 as diagnostic biomarkers in calves with sepsis

“…Even in humans, sepsis, which is often the most severe manifestation of acute infection, can cause multiple-organ failure and lead to death in 30-50% of cases. Thus, early diagnosis remains important in hospitalised patients with sepsis (Engel et al 2007; Angus and Van der Poll 2013) for the initiation of evidencebased treatment and therapeutic interventions as https://doi.org/10.17221/159/2017-VETMED required to increase the chances of survival (Levy et al 2012;Nachimuthu and Haug 2012;Prucha 2015). Biomarkers, such as thrombomodulin (TM) (Hao and Wang 2013;Kim et al 2016) and pentraxin-3 (PTX3) (Vanska et al 2011;Uusitalo-Seppala et al 2013), play an important role in both early diagnosis of the deseases and follow-up treatment (Christ-Crain and Muller 2007;Faix 2013).…”

Predictors of treatment failure and clinical stability in patients with community acquired pneumonia

“…CRP is predominantly synthesized in the liver in response to IL-6 induction of CRP mRNA (27,31). The single determinant of CRP level is the rate of synthesis in the liver in response to the inflammation intensity (27,32).…”

“…In this way it is superior to more complex acute phase characteristics such as leukocytosis and fever (27). PCT is a 116 amino acid prohormone of calcitonin (31). In the event of a bacterial infection the CALC-1 gene is up regulated producing PCT in large amounts by macrophage and monocytic cells throughout the body especially the liver, lung and intestine (33).…”

“…Ideally biomarkers should be of high specificity and sensitivity, and useful for characterizing severity and monitoring response to treatment even in the absence of clinical signs (31,41). It is well described that patients with severe CAP who mount an excessive systemic pro inflammatory response are more likely to have a deleterious outcome.…”