Biomarkers of sepsis

Abstract

Sepsis is an unusual systemic reaction to what is sometimes an otherwise ordinary infection, and it probably represents a pattern of response by the immune system to injury. A hyper-inflammatory response is followed by an immunosuppressive phase during which multiple organ dysfunction is present and the patient is susceptible to nosocomial infection. Biomarkers to diagnose sepsis may allow early intervention which, although primarily supportive, can reduce the risk of death. Although lactate is currently the most commonly used biomarker to identify sepsis, other biomarkers may help to enhance lactate’s effectiveness; these include markers of the hyper-inflammatory phase of sepsis, such as pro-inflammatory cytokines and chemokines; proteins such as C-reactive protein and procalcitonin which are synthesized in response to infection and inflammation; and markers of neutrophil and monocyte activation. Recently, markers of the immunosuppressive phase of sepsis, such as anti-inflammatory cytokines, and alterations of the cell surface markers of monocytes and lymphocytes have been examined. Combinations of pro- and anti-inflammatory biomarkers in a multi-marker panel may help identify patients who are developing severe sepsis before organ dysfunction has advanced too far. Combined with innovative approaches to treatment that target the immunosuppressive phase, these biomarkers may help to reduce the mortality rate associated with severe sepsis which, despite advances in supportive measures, remains high.

Experience with IgM-Enriched Immunoglobulins as Adjuvant Therapy in Septic Patient after Redo Cardiac Surgery

“…No single biomarker of sepsis may be ideal, but many are helpful in terms of identifying critically ill patients [8]. The procalcitonin (PCT) is the reliable biomarker for identifying systemic bacterial infection and sepsis diagnosis [9].…”

Ang-2, Tie-2, and Ang-2/Tie-2 ratio serum levels as diagnostic and prognostic biomarkers of sepsis in critically ill patients

“…Evidence of organ dysfunction may also be present in patients with severe sepsis [2], with delays in treatment predisposing to increased mortality; on the other hand, early diagnosis and the administration of effective antibiotic therapy may improve the survival rate of septic patients [3].…”

“…A broad range of clinical and laboratory parameters define the diagnostic standard of severe sepsis and septic shock [2]. Blood culture remains the gold standard method for detecting the presence of microorganisms in the bloodstream but usually requires several days for results to be known, as well as being plagued by some false negative cases, especially in patients undergoing antibiotic therapy [5].…”

“…Sepsis is a pathology frequent encountered in intensive care units [ICU], defined as the combination of an infection with two or more criteria for the systemic inflammatory response syndrome (SIRS) [1] and together with severe sepsis and septic shock are among the most frequent reasons for admission to an intensive care unit (ICU) [2]. The Surviving Sepsis Campaign (SSC), was conducted with the aim of establishing new criteria for defining sepsis and septic shock, and their guidelines define sepsis as "the presence, probable or documented, of infection together with systemic manifestations of infection" [3,4].…”

Economic evaluation of procalcitonin-guided antibiotic therapy in acute respiratory infections: a US health system perspective

“…Biomarkers have shown to be very effective in aiding diagnosis and management of hospital patients with suspected systemic bacterial infections, including community-acquired pneumonia (CAP) and sepsis [9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28]. Procalcitonin (PCT) is a novel and effective marker of assumed bacterial infections that safely helps guide antibiotic therapy in acute respiratory tract infections (ARI) and sepsis in hospitals [5,[29][30][31][32][33][34][35][36][37][38][39][40].…”