von Groote Thilo, Meersch-Dini Melanie
Department of Anaesthesiology, Intensive Care and Pain Medicine, University Hospital Muenster, D-48149 Muenster, Germany.
J Clin Med. 2022 Sep 29;11(19):5782. doi: 10.3390/jcm11195782.
Sepsis and septic shock are a major public health concern and are still associated with high rates of morbidity and mortality. Whilst there is growing understanding of different phenotypes and endotypes of sepsis, all too often treatment strategies still only employ a "one-size-fits-all" approach. Biomarkers offer a unique opportunity to close this gap to more precise treatment approaches by providing insight into clinically hidden, yet complex, pathophysiology, or by individualizing treatment pathways. Predicting and evaluating systemic inflammation, sepsis or septic shock are essential to improve outcomes for these patients. Besides opportunities to improve patient care, employing biomarkers offers a unique opportunity to improve clinical research in patients with sepsis. The high rate of negative clinical trials in this field may partly be explained by a high degree of heterogeneity in patient cohorts and a lack of understanding of specific endotypes or phenotypes. Moving forward, biomarkers can support the selection of more homogeneous cohorts, thereby potentially improving study conditions of clinical trials. This may finally pave the way to a approach to sepsis, septic shock and complication of sepsis in the future.
脓毒症和感染性休克是主要的公共卫生问题,并且仍然与高发病率和死亡率相关。虽然人们对脓毒症的不同表型和内型的认识不断增加,但治疗策略往往仍然只采用“一刀切”的方法。生物标志物提供了一个独特的机会,通过深入了解临床上隐藏但复杂的病理生理学,或通过使治疗途径个体化,来缩小与更精确治疗方法之间的差距。预测和评估全身炎症、脓毒症或感染性休克对于改善这些患者的预后至关重要。除了改善患者护理的机会外,使用生物标志物还为改善脓毒症患者的临床研究提供了独特的机会。该领域临床试验的高阴性率可能部分归因于患者队列的高度异质性以及对特定内型或表型的缺乏了解。展望未来,生物标志物可以支持选择更同质的队列,从而有可能改善临床试验的研究条件。这最终可能为未来治疗脓毒症、感染性休克和脓毒症并发症的方法铺平道路。