Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Exp Med. May 20, 2015; 5(2): 50-63
Published online May 20, 2015. doi: 10.5493/wjem.v5.i2.50
Are there new approaches for diagnosis, therapy guidance and outcome prediction of sepsis?
Dubravka Kojic, Benedikt H Siegler, Florian Uhle, Christoph Lichtenstern, Peter P Nawroth, Markus A Weigand, Stefan Hofer, Thorsten Brenner
Dubravka Kojic, Benedikt H Siegler, Florian Uhle, Christoph Lichtenstern, Markus A Weigand, Stefan Hofer, Thorsten Brenner, Department of Anesthesiology, Heidelberg University Hospital, 69120 Heidelberg, Germany
Peter P Nawroth, Department of Internal Medicine I and Clinical Chemistry, Heidelberg University Hospital, 69120 Heidelberg, Germany
Author contributions: Kojic D and Siegler BH contributed equally to this work; Kojic D and Siegler BH analyzed data and wrote the paper, Uhle F, Lichtenstern C, Nawroth PP, Weigand MA, Hofer S and Brenner T analyzed data.
Conflict-of-interest: None.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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:
Correspondence to: Dr. Dubravka Kojic, Department of Anesthesiology, Heidelberg University Hospital, Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany.
Telephone: +49-6221-5638294 Fax: +49-6221-565345
Received: November 27, 2014
Peer-review started: November 27, 2014
First decision: December 26, 2014
Revised: January 9, 2015
Accepted: March 30, 2015
Article in press: April 2, 2015
Published online: May 20, 2015

Beside many efforts to improve outcome, sepsis is still one of the most frequent causes of death in critically ill patients. It is the most common condition with high mortality in intensive care units. The complexity of the septic syndrome comprises immunological aspects - i.e., sepsis induced immunosuppression - but is not restricted to this fact in modern concepts. So far, exact mechanisms and variables determining outcome and mortality stay unclear. Since there is no typical risk profile, early diagnosis and risk stratification remain difficult, which hinders rapid and effective treatment initiation. Due to the heterogeneous nature of sepsis, potential therapy options should be adapted to the individual. Biomarkers like C-reactive protein and procalcitonin are routinely used as complementary tools in clinical decision-making. Beyond the acute phase proteins, a wide bunch of promising substances and non-laboratory tools with potential diagnostic and prognostic value is under intensive investigation. So far, clinical decision just based on biomarker assessment is not yet feasible. However, biomarkers should be considered as a complementary approach.

Keywords: Clinical decision-making, Biomarkers, Early prediction, Sepsis and mortality

Core tip: Sepsis is a complex continuum of disturbed systems. Despite the presence of clinical consensus criteria, the early diagnosis especially in the perioperative setting is challenging. A magnitude of potential new biomarkers is tested for this purpose, but evidence is mounting that due to the complex nature of the syndrome, biomarkers are rather complementary tools for clinical decision making than “magic bullets”. Moreover, biomarkers are also evaluated for therapy guidance, linking diagnostic results to an individual therapeutic regime. This review summarizes the developments in the biomarker field, aiming to provide an overview about current targets and their limitations.