Could Biomarkers Direct Therapy for the Septic Patient?

Abstract

Sepsis is a serious medical condition caused by a severe systemic inflammatory response to a bacterial, fungal, or viral infection that most commonly affects neonates and the elderly. Advances in understanding the pathophysiology of sepsis have resulted in guidelines for care that have helped reduce the risk of dying from sepsis for both children and older adults. Still, over the past three decades, a large number of clinical trials have been undertaken to evaluate pharmacological agents for sepsis. Unfortunately, all of these trials have failed, with the use of some agents even shown to be harmful. One key issue in these trials was the heterogeneity of the patient population that participated. What has emerged is the need to target therapeutic interventions to the specific patient's underlying pathophysiological processes, rather than looking for a universal therapy that would be effective in a "typical" septic patient, who does not exist. This review supports the concept that identification of the right biomarkers that can direct therapy and provide timely feedback on its effectiveness will enable critical care physicians to decrease mortality of patients with sepsis and improve the quality of life of survivors.

Fig. 1.

Conceptual framework for the use of the discussed biomarkers in combination to direct the development, validation, and use of targeted therapies.

Fig. 2.

Age, genetics, environmental factors, and comorbidities contribute to the diversity of septic patients, with the young and the elderly populations being the most susceptible to sepsis. As the SIRS and sepsis progress to severe sepsis with MODS, biomarkers could be used to guide targeted therapy that would halt the progression of sepsis to increase survival and decrease morbidity.