The pediatric sepsis biomarker risk model: potential implications for sepsis therapy and biology

Abstract

Sepsis remains a major cause of morbidity and mortality in adult and pediatric intensive care units. Heterogeneity of demographics, comorbidities, biological mechanisms, and severity of illness leads to difficulty in determining which patients are at highest risk of mortality. Determining mortality risk is important for weighing the potential benefits of more aggressive interventions and for deciding whom to enroll in clinical trials. Biomarkers can be used to parse patients into different risk categories and can outperform current methods of patient risk stratification based on physiologic parameters. Here we review the Pediatric Sepsis Biomarker Risk Model that has also been modified and applied to estimate mortality risk in adult patients. We compare the two models and speculate on the biological implications of the biomarkers in patients with sepsis.

Keywords::

• biomarker
• pediatric
• PERSEVERE
• risk stratification
• sepsis

Financial & competing interests disclosure

The authors were Supported by National Institutes of Health Grants RC1HL100474, RO1GM064619 and RO1GM099773 and supported in part by an Institutional Clinical and Translational Science Award, NIH/NCRR 8UL1 TR000077. HR Wong has submitted provisional patent applications for the PERSEVERE biomarkers described in this review. CJ Lindsell is named as a co-inventor in this patent application. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.

Key issues

• Sepsis is a heterogeneous disease in terms of population, causes, comorbidities and immune state.

• Biomarker-based stratification tools can be used to decide which patients are at highest risk for death or complicated outcome.

• Biomarkers provide a snap shot of sepsis biology based on selected biomarkers.

• Future sepsis interventional clinical trials could include biomarker-based data to select patients most likely to benefit from a given experimental intervention.

• Using biomarkers to profile sepsis biology for individual patients may ultimately guide personalized therapy.

Notes