Combining biomarkers to improve sepsis diagnosis in the intensive care unit

Abstract

Sepsis is the leading cause of death in the intensive care unit. Prompt diagnosis has come to be appreciated as the primary determinant of good outcome. Because clinical signs are neither sensitive nor specific enough for the diagnosis of sepsis, critical care practitioners are awaiting biological tools capable of improving their ability to distinguish those patients requiring antimicrobial therapies. Several biomarkers are widely used, such as C-reactive protein or procalcitonin; many others are still in the field of research, like soluble triggering receptor expressed on myeloid cells-1 (sTREM-1). Taken separately, none of these biomarkers has sufficient accuracy to differentiate sepsis from other non-infectious causes of systemic inflammatory response syndrome, especially in critical care medicine; however, the additional information contained in their joint interpretation could overcome these limitations. Development of molecular biology including proteomics could allow the development of better sepsis biomarkers, whose usefulness will be increased by their integration into biological scores. At last, unlike current microbiological culture techniques, polymerase chain reaction techniques could allow the identification of microorganisms in a timeframe compatible with the severity of this complex disease.