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World J Crit Care Med. Sep 9, 2023; 12(4): 188-203
Published online Sep 9, 2023. doi: 10.5492/wjccm.v12.i4.188
Biomarkers in sepsis-looking for the Holy Grail or chasing a mirage!
Neelmani Ahuja, Anjali Mishra, Ruchi Gupta, Sumit Ray
Neelmani Ahuja, Anjali Mishra, Ruchi Gupta, Sumit Ray, Department of Critical Care Medicine, Holy Family Hospital, Delhi 110025, India
Author contributions: All the authors were equally involved in the designing, research methodology, data collection and writing of the manuscript.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Sumit Ray, MBBS, MD, Director, Department of Critical Care Medicine, Holy Family Hospital, Okhla Road, Delhi 110025, India.
Received: March 13, 2023
Peer-review started: March 13, 2023
First decision: April 28, 2023
Revised: May 12, 2023
Accepted: June 12, 2023
Article in press: June 12, 2023
Published online: September 9, 2023

Sepsis is defined as a life-threatening organ dysfunction caused by the dysregulated host response to infection. It is a complex syndrome and is characterized by physiologic, pathologic and biochemical abnormalities in response to an infection. Diagnosis of sepsis is based on history, physical examination and other investigations (including biomarkers) which may help to increase the certainty of diagnosis. Biomarkers have been evaluated in the past for many diseases and have been evaluated for sepsis as well. Biomarkers may find a possible role in diagnosis, prognostication, therapeutic monitoring and anti-microbial stewardship in sepsis. Since the pathophysiology of sepsis is quite complex and is incompletely understood, a single biomarker that may be robust enough to provide all information has not been found as of yet. However, many biomarkers have been studied and some of them have applications at the bedside and guide clinical decision-making. We evaluated the PubMed database to search for sepsis biomarkers for diagnosis, prognosis and possible role in antibiotic escalation and de-escalation. Clinical trials, meta-analyses, systematic reviews and randomized controlled trials were included. Commonly studied biomarkers such as procalcitonin, Soluble urokinase-type plasminogen activator (Supar), presepsin, soluble triggering receptor expressed on myeloid cells 1, interleukin 6, C-reactive protein, etc., have been described for their possible applications as biomarkers in septic patients. The sepsis biomarkers are still an area of active research with newer evidence adding to the knowledge base continuously. For patients presenting with sepsis, early diagnosis and prompt resuscitation and early administration of anti-microbials (preferably within 1 h) and source control are desired goals. Biomarkers may help us in the diagnosis, prognosis and therapeutic monitoring of septic patients. The marker redefining our view on sepsis is yet a mirage that clinicians and researchers continue to chase.

Keywords: Sepsis, Sepsis biomarkers, Procalcitonin, Presepsin, Omics

Core Tip: Sepsis is defined as life threatening organ dysfunction caused by a dysregulated host response to infection. Early diagnosis of sepsis and prompt initiation of antimicrobials is essential. Biomarkers may be helpful in early diagnosis, prognostication and monitoring of response to therapy in septic patients. We review commonly used biomarkers such as procalcitonin, presepsin, soluble urokinase plasminogen activator, etc., and their utility in clinical practice.