Biomarkers of Sepsis

Abstract

Sepsis remains a leading cause of death in critically ill patients, despite efforts to improve patient outcome. Thus far, no magic drugs exist for severe sepsis and septic shock. Instead, early diagnosis and prompt initial management such as early goal-directed therapy are key to improve sepsis outcome. For early detection of sepsis, biological markers (biomarkers) can help clinicians to distinguish infection from host response to inflammation. Ideally, biomarkers can be used for risk stratification, diagnosis, monitoring of treatment responses, and outcome prediction. More than 170 biomarkers have been identified as useful for evaluating sepsis, including C-reactive protein, procalcitonin, various cytokines, and cell surface markers. Recently, studies have reported on the usefulness of biomarker-guided antibiotic stewardships. However, the other side of these numerous biomarkers is that no novel single laboratory marker can diagnose, predict, and track the treatment of sepsis. The purpose of this review is to summarize several key biomarkers from recent sepsis studies.

Biomarker-guided antibiotic therapy—strengths and limitations

“…It starts falling after the removal of the primary inflammatory stimulus following a first-order kinetic elimination pattern with a half-life of 19 h. Its production and elimination is not influenced by renal replacement therapy or immunosuppression (both systemic steroids and neutropenia). It has a sensitivity of 68-92% and a specificity of 40-67% as a marker of bacterial infection (9). The available assays for CRP measurement are reliable, stable, reproducible, rapid, inexpensive (€4 in Europe) and present an acceptable limit of detection (0.3-5 mg/L).…”

“…It is released 3-4 h after an inflammatory stimulus with a plasmatic peak within 6-24 h (8) and a half-life ranging from 22 to 35 h. Its plasmatic levels are markedly influenced by renal function, different techniques of renal replacement therapy and neutropenia. It showed a sensitivity of 77% and a specificity of 79% for early diagnosis of sepsis in critically ill patients (9). The laboratory assay used to measure plasma PCT must assure a high sensitivity in order to validate study results.…”

Pro-Inflammatory Cytokines in Sepsis: Biological Studies and Prospects From In Silico Research

“…It is hoped that the complexity involved in the various interactions between pathogen and host cells and their products in the development of sepsis [42] may be discovered and better understood by application of computational modelling [47]. Additionally, use of biomarkers in the diagnosis of the disease may allow for early intervention [17], direct choice of antibiotic therapy [15], and reduce consequent risk of fatality [17].…”

Serial Evaluation of Abdominal Fluid and Serum Amino‐terminal pro‐C‐type Natriuretic Peptide in Dogs with Septic Peritonitis

“…Diagnostic biomarkers are measurable and quantifiable substances that can indicate the likely presence of a disease or a physiologic abnormality 1. The use of molecular biomarkers is receiving increasing attention because of the advances in technology and the difficulties encountered in diagnosing many conditions using standard test methods.…”

“…The use of molecular biomarkers is receiving increasing attention because of the advances in technology and the difficulties encountered in diagnosing many conditions using standard test methods. Better understanding of disease pathogenesis has allowed the identification of specific biomarkers that are being used to screen patients at risk for a variety of diseases, as well as to evaluate response to therapy and predict outcome 1. Among others, amino‐terminal pro‐C‐type natriuretic peptide (NT‐proCNP), a stable product of cleavage of C‐type natriuretic peptide (CNP), is a novel biomarker with potential diagnostic utility in sepsis 2, 3, 4…”