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Review
. 2025 Jul 21;15(1):103.
doi: 10.1186/s13613-025-01524-1.

Biomarkers to guide sepsis management

Vasiliki Bourika #  1 , Evangelia-Areti Rekoumi #  1 , Evangelos J Giamarellos-Bourboulis  2   3
Affiliations
Review

Biomarkers to guide sepsis management

Vasiliki Bourika et al. Ann Intensive Care. .

Abstract

Background: Sepsis remains a major cause of morbidity and mortality. Precision therapeutics are now regarded as a novel prospective to improve outcome. This approach relies on biomarkers to identify a pathway of pathogenesis which prevails and directs the best available therapeutic option to modulate this pathway. This review provides the most recent findings on biomarkers for bacterial or viral sepsis. These biomarkers provide guidance for prompt diagnosis and management tailored to specific needs.

Main body: Keywords relative to sepsis management (early recognition, antibiotic administration, selection of fluids, vasopressors and immunotherapy) were searched across PubMed database. Published evidence the last five years exists for heparin-binding protein (HBP), monocyte distribution width (MDW), interleukin-10 (IL-10), presepsin, procalcitonin and C-reactive protein (CRP) for early sepsis diagnosis; procalcitonin is the most well-studied biomarker for antibiotic guidance. Endothelial and cardiac biomarkers have been explored as tools to tailor circulatory support in sepsis, including fluid therapy, and the targeted use of vasopressors for vascular tone optimization.

Conclusion: This review explored how biomarkers can optimize immunomodulatory therapies, guide vasopressor initiation, inform antibiotic stewardship, and aid in fluid resuscitation decisions, ultimately improving patient outcomes.

Keywords: Antibiotics; Biomarkers; Fluids; Guidance; Sepsis; Vasopressors.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: Not applicable. Consent for publication: Not applicable. Competing interests: EJG-B reports honoraria from Abbott Products Operations, bioMérieux, Brahms GmbH, GSK, InflaRx GmbH, Sobi and Xbiotech Inc; independent educational grants from Abbott Products Operations, bioMérieux Inc, Johnson & Johnson, MSD, UCB, Swedish Orphan Biovitrum AB; and funding from the Horizon 2020 European Grants ImmunoSep and RISCinCOVID and the Horizon Health grants EPIC-CROWN-2, POINT and Homi-Lung (granted to the Hellenic Institute for the Study of Sepsis). The other authors do not have any conflict to disclose.

Figures

Fig. 1
Fig. 1
Principles of sepsis management
Fig. 2
Fig. 2
Retrieval process of literature research using the PubMed database for the review of biomarkers to guide sepsis management
Fig. 3
Fig. 3
Suggested algorithm for early sepsis recognition and management
See this image and copyright information in PMC

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