Commentary: Letter to the Editor "Austere Environments Consortium for Enhanced Sepsis Outcomes (ACESO)".

Abstract

The authors read with great interest the letter to the editor by Dr Krishnan and colleagues regarding evidence-based strategies to improve survival in low-resource settings. The authors rightly illuminate that there are insufficient measures to decrease the burden of sepsis in low-resource settings despite a global effort by the United Nations World Health Assembly. Furthermore, the authors offer an insightful perspective to these efforts, highlighting work performed by the Austere environments Consortium for Enhanced Sepsis Outcomes (ACESO). ACESO is headquartered at the Naval Medical Research Center and consists of US government, non-profit, academic, and industry partners with an overall mission to improve survival from sepsis. The military has long dealt with problems of resource management and allocation to remote locations and areas with suboptimal infrastructure, and can bring that experience toward improving survival from sepsis in austere environments. In their letter, Dr Krishnan et al. concisely explain the goals of ACESO to guide and improve clinical care solutions in settings where modern intensive care unit facilities are not available. These clinical solutions are particularly important in pandemic and other public health emergency settings that could lead to humanitarian crises and potentially pose a national security threat. The authors particularly highlight their goals to improve decision making at the point-of-care by developing host-based biomarkers using multiomics data, deploying field-ready point of care devices to carry out biomarker testing, utilization of biomarker results to stratifying patients for targeted therapies, and developing evidence-based care guidelines. ACESO aims to use advanced analytics and machine learning to guide patient management which is an exciting potential application for personalized medicine in sepsis, particularly in low-resource settings. With the burgeoning field of genomics and proteomics as well as improved processing capacity to better understand “big data,” this approach is exciting and has great potential to shape the future of sepsis care globally. In their letter, the authors describe the impressive research undertaken by ACESO with approximately 1,000 enrolled subjects across five countries with suspected sepsis, specifically seeking to accommodate wide ranges of geographic, ethnic, and etiologic diversity. Building the infrastructure to accomplish ACESO's mission locally and abroad has far-reaching positive effects, raising the potential for a global network of easily-deployed testing, standardized data collection, and improved provision of care. Personalized medicine, with subgroup-specific intervention, is the future of sepsis care. The authors greatly appreciate the authors highlighting the important work ACESO is performing to bring novel diagnostics and therapeutics to underserved areas globally, and we eagerly await learning more about the results of this critical work.