Emerging infection and sepsis biomarkers: will they change current therapies?

ABSTRACT

Introduction: Sepsis is a heterogeneous syndrome characterized by both immune hyperactivity and relative immune suppression. Biomarkers have the potential to improve recognition and management of sepsis through three main applications: diagnosis, monitoring response to treatment, and stratifying patients based on prognosis or underlying biological response.

Areas covered: This review focuses on specific examples of well-studied, evidence-supported biomarkers, and discusses their role in clinical practice with special attention to antibiotic stewardship and cost-effectiveness. Biomarkers were selected based on availability of robust prospective trials and meta-analyses which supported their role as emerging tools to improve the clinical management of sepsis.

Expert commentary: Great strides have been made in candidate sepsis biomarker discovery and testing, with the biomarkers in this review showing promise. Yet sepsis remains a dynamic illness with a great degree of biological heterogeneity – heterogeneity which may be further resolved by recently discovered gene expression-based endotypes in septic shock.

KEYWORDS:

• Sepsis
• immune system
• IL-27
• procalcitonin
• presepsin
• nCD64
• cfDNA
• bioscore
• PERSEVERE
• endotype

Declaration of interest

H Wong and his institution hold a patent US patents for the PERSEVER biomarkers described in the review. 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.

Additional information

Funding

This paper has been supported by grants from the National Institutes of Health.