Microcirculation Alteration and Biomarker Dilemma in Early Septic Shock Diagnosis and Treatment.

Abstract

Septic shock is represented by severe hemodynamic changes which are manifested with failure of organ systems and high mortality. Early diagnosis together with timely and appropriate treatment is important to attain better outcome. We reviewed the diagnostic approach of septic shock in relation to the microcirculatory abnormalities, novel biomarkers, monitoring, interventions, and therapy. A narrative literature review was carried out using PubMed, MEDLINE and Google scholar search engines. Septic shock is characterized by extensive microcirculatory alterations. These changes are diverse in nature and lead to inconsistency of response to various interventions. The severity of these abnormalities correlates with the patient prognosis. The pathophysiology of septic shock is highly complex which requires better understanding of disease progression and risk-stratification based on potential sepsis biomarkers such as lactic acid, procalcitonin, C-reactive protein, cytokines, and novel molecular markers. The newly identified candidate biomarkers include soluble Triggering Receptor Expressed on myeloid cells-1, presepsin, soluble urokinase-type Plasminogen Receptor and pro-adrenomedullin, but their clinical utilities still need to be validated by large prospective clinical trials. A number of promising therapies for the management of severe sepsis and septic shock has been proposed with potential implications. It is crucial to improve microvascular perfusion through targeted interventions using patient-centred approach. Moreover, systems biology approach could play a promising role in understanding the immune complexity, characterization of gene expression patterns, and recognition of novel therapeutic targets which could be used as clinical decision making tool in the future.