Intensive care medicine in 2050: precision medicine

Wong, Hector R.

doi:10.1007/s00134-017-4727-y

Cited by 46 publications

(46 citation statements)

References 15 publications

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“…Precision medicine is founded on the concept that therapies can be customized based on the unique phenotypic and molecular features of each patient, and relies on enrichment strategies that can that can disentangle the patient heterogeneity and determine which interventions will be most effective [5]. However, these strategies require clear understanding of the biological mechanisms that contribute to the disease process.…”

Section: Introductionmentioning

confidence: 99%

Early Diagnosis of Sepsis: Is an Integrated Omics Approach the Way Forward?

Wong

2017

Mol Diagn Ther

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Sepsis remains one of the leading causes of death in the United States and it is expected to get worse as the population ages. Moreover, the standard of care, which recommends aggressive treatment with appropriate antibiotics, has led to an increase in multiple drug resistant organisms (MDROs). There is a dire need for the development of new antibiotics, improved antibiotic stewardship and therapies that treat the host response. Development of new sepsis therapeutics has been a disappointment as no drugs are currently approved to treat the various complications from sepsis. Much of the failure has been blamed on animal models that do not accurately reflect the course of the disease. However, recent improvements in metabolomic, transcriptomic, genomic and proteomic platforms have allowed for a broad spectrum look at molecular changes in the host response using clinical samples. Integration of these multi-omic data sets allows researchers to perform systems biology approaches to identify novel pathophysiology of the disease. In this review, we will highlight what is currently known about sepsis and how integrative omics has identified new diagnostic and predictive models of sepsis as well as novel mechanisms. These changes may improve patient care as well as guide future preclinical analysis of sepsis.

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Section: Introductionmentioning

confidence: 99%

Early Diagnosis of Sepsis: Is an Integrated Omics Approach the Way Forward?

Wong

2017

Mol Diagn Ther

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“…How can we overcome the challenges mentioned above? One solution could be the application of precision medicine, which is increasingly common in the field of intensive care medicine [16]. One example is the application of prognostic and predictive enrichment strategies to find populations that could benefit from corticosteroid treatments in sepsis [17].…”

Section: Main Textmentioning

confidence: 99%

Should we treat sepsis-induced DIC with anticoagulants?

Inata

2020

j intensive care

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Background: Disseminated intravascular coagulation (DIC) is a common complication in sepsis because of crosstalk between the immune system and the coagulation system. Several anticoagulant agents have been tested in an attempt to improve the survival of patients with sepsis and sepsis-induced DIC. Here, we discuss the rationale against using anticoagulation therapy in septic DIC. Main body of the abstract: Coagulopathy and DIC are associated with increased mortality in sepsis. Several anticoagulant agents have been tested in an attempt to improve the survival of patients with sepsis and sepsisinduced DIC, but have proven largely ineffective. This is because of two major factors. First, the coagulation system is complex and closely related to the immune system. When we manipulate one of the factors involved in these systems, we may disturb the delicate homeostasis between them. A second factor may be failure to identify patients who will benefit from anticoagulation therapy. This may be attributed partly to the fact that there is no gold standard for the diagnosis of DIC, and there are consequently several diagnostic criteria, none of which are specifically designed for sepsis-induced DIC. Application of precision medicine, of the kind currently being applied in other intensive care fields, may be the key to overcoming these challenges. Until we know the precise target population, we should not use anticoagulation therapy in sepsis-induced DIC outside a research setting. Short conclusion: There is no strong evidence to support the effectiveness of routine anticoagulation therapy in sepsis-induced DIC, and it should not be used clinically until more is known regarding the population of patients who may benefit from it.

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“…Refining our predictive capability while being able to understand the difference between a discriminative model and an adequately calibrated one is one of the first steps towards adequate prediction and risk stratification [16], which may allow identification of phenotype, and ultimately individualization of treatments [17]. Our goal as intensivists in the coming years will be to broaden our views and address the combined challenges of unstable clinical conditions, complex ethical issues, and the imperative for individualized care, which respects patient values (Fig.…”

Section: Thinking Wider and More Globallymentioning

confidence: 99%