Abstract
IntroductionBiomarkers can be useful for identifying or ruling out sepsis, identifying patients who may benefit from specific therapies or assessing the response to therapy.MethodsWe used an electronic search of the PubMed database using the key words "sepsis" and "biomarker" to identify clinical and experimental studies which evaluated a biomarker in sepsis.ResultsThe search retrieved 3370 references covering 178 different biomarkers.ConclusionsMany biomarkers have been evaluated for use in sepsis. Most of the biomarkers had been tested clinically, primarily as prognostic markers in sepsis; relatively few have been used for diagnosis. None has sufficient specificity or sensitivity to be routinely employed in clinical practice. PCT and CRP have been most widely used, but even these have limited ability to distinguish sepsis from other inflammatory conditions or to predict outcome.
Highlights
Biomarkers can be useful for identifying or ruling out sepsis, identifying patients who may benefit from specific therapies or assessing the response to therapy
It remains difficult to differentiate sepsis from other noninfectious causes of systemic inflammatory response syndrome [16], and there is a continuous search for better biomarkers of sepsis. With this background in mind, we reviewed the literature on sepsis biomarkers that have been used in clinical or experimental studies to help better evaluate their utility
We identified three biomarkers with high negative predictive value to rule out sepsis: PCT (99% at a cut-off value of 0.2 ng/ml) [34]; activated partial thromboplastin time waveform (96%) [35]; and fibrin degradation products (100% for Gram-negative sepsis by enzyme-linked immunosorbent assay (ELISA) assay) [36]
Summary
Biomarkers can be useful for identifying or ruling out sepsis, identifying patients who may benefit from specific therapies or assessing the response to therapy. The diagnosis of sepsis and evaluation of its severity is complicated by the highly variable and non-specific nature of the signs and symptoms of sepsis [4]. Biomarkers can have an important place in this process because they can indicate the presence or absence or severity of sepsis [7,8], and can differentiate bacterial from viral and fungal infection, and systemic sepsis from local infection. Other potential uses of biomarkers include roles in prognostication, guiding antibiotic therapy, evaluating the response to therapy and recovery from sepsis, differentiating Gram-positive from Gramnegative microorganisms as the cause of sepsis, predicting sepsis complications and the development of organ dysfunction (heart, kidneys, liver or multiple organ dysfunction). The exact role of biomarkers in the management of septic patients remains undefined [9]
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