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Do sepsis biomarkers in the emergency room allow transition from bundled sepsis care to personalized patient care?
Journal
Current Opinion in Critical Care
Volume
18
Number
4
Pages
341-349
Keywords
Adrenomedullin/blood; Anti-Bacterial Agents/therapeutic use; Biological Markers/*analysis/blood; Calcitonin/blood; *Emergency Service, Hospital; Humans; *Intensive Care Units; *Patient Care; Practice Guidelines as Topic; Prognosis; Protein Precursors/blood; Risk Assessment; Sepsis/*diagnosis/drug therapy
Abstract
PURPOSE OF REVIEW: There is convincing evidence linking early start of fluid resuscitation and initiation of appropriate antimicrobial therapy to improved outcomes in patients with sepsis in the emergency department. Blood biomarkers measured on admission and during follow-up have the ability to guide early sepsis recognition, severity assessment and therapeutic decisions in individual patients and may allow transition from bundled sepsis care to more individualized management in single patients. RECENT FINDINGS: Although a large number of promising diagnostic and prognostic biomarkers have been put forward in observational studies, only few have been evaluated in prospective randomized-controlled intervention trials. Markers such as lactate for risk stratification and guidance of fluid resuscitation, procalcitonin for assessing risk of bacterial infections and guiding therapeutic decisions about initiation and duration of antimicrobial therapy, and recently proadrenomedullin for early mortality prediction and site-of-care decisions in respiratory infections, have shown to improve patient management. SUMMARY: For few biomarkers, recent study results demonstrate that well defined clinical protocols have the potential to guide decisions about the individual risk stratification and treatment of patients with suspicion of sepsis ultimately leading to improved patient care and outcomes. For other biomarkers, promising observation data have been put forward, but their potential needs to be evaluated in large-scale, well designed prospective intervention studies before clinical use can be recommended.
