Precision medicine in sepsis: usefulness of biomarkers In critically ill patientsbiomarkers In critically ill patient

Medicina de precisión en sepsis: utilidad de los biomarcadores en pacientes biomarcadores en pacientes críticamente enfermos

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Daniel Molano
Mario Gómez
Edgar Beltrán
Mario Villabón
Ivan Felipe Robayo Valbuena
Felipe Franco
Jorge Cárdenas
Álvaro Estupiñán
Guillermo Sánchez
Ingrid Arévalo
Javier Zamora

Abstract

For many years, critical care practice has been based on protocols and management guidelines categorized by pathologies or syndromes. Although mortality caused by various diseases such as sepsis, acute coronary syndrome and acute respiratory distress has decreased, clinical problems, particularly diagnosis and management, have not been completely resolved. A new option known as “precision medicine” is on the horizon, a prevention and treatment strategy based on individual variability. Sepsis is a syndrome encompassing multiple clinical phenotypes and genotypes coding and a prompt diagnosis is relevant to obtain better outcomes. To this moment the main approach has been the identification of microorganisms causing sepsis to distinguish sepsis from systemic inflammatory response (SIRS). Infectious diseases paradigm has changed during recent years due to studies demonstrating how septic patient immune response plays a key role in the development of the disease, with implications on diagnosis, prognosis and treatment, which may help change the approach in the next years thanks to a strategy based on precision medicine. Today microbiological identification and cultures continue to be the reference standard with several disadvantages such as turnaround time for test results predominantly in infections caused by resistant bacteria or fungi that may delay commencement of antibiotic therapy. The use of sepsis biomarkers determined by the individual´s inflammatory response to infection have been proposed as a useful alternative for establishing diagnosis and prognosis mainly in critically ill patients. We decided to conduct this narrative review on the usefulness of biomarkers in critically ill septic patients using a personalized medicine model.

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Author Biographies

Daniel Molano, Fundación Universitaria Ciencias de la Salud

Medicina Crítica y Cuidado Intensivo, Fundación Universitaria de Ciencias de la Salud, Bogotá DC, Colombia.

Mario Gómez, Fundación Universitaria Ciencias de la Salud

Medicina Crítica y Cuidado Intensivo, Fundación Universitaria de Ciencias de la Salud, Bogotá DC, Colombia.

Edgar Beltrán, Hospital de San José

Medicina Crítica y Cuidado Intensivo, Fundación Universitaria de Ciencias de la Salud, Bogotá DC, Colombia.

Mario Villabón, Hospital de San José

Medicina Crítica y Cuidado Intensivo, Fundación Universitaria de Ciencias de la Salud, Bogotá DC, Colombia.

Ivan Felipe Robayo Valbuena, Fundacion Universitaria de Ciencias de la Salud

Medicina Crítica y Cuidado Intensivo, Fundación Universitaria de Ciencias de la Salud, Bogotá DC, Colombia.

Felipe Franco, Fundación Universitaria Ciencias de la Salud

Medicina Crítica y Cuidado Intensivo, Fundación Universitaria de Ciencias de la Salud, Bogotá DC, Colombia.

Jorge Cárdenas, Fundación Universitaria Ciencias de la Salud

Medicina Crítica y Cuidado Intensivo, Fundación Universitaria de Ciencias de la Salud, Bogotá DC, Colombia.

Álvaro Estupiñán, Fundación Universitaria Ciencias de la Salud

Medicina Crítica y Cuidado Intensivo, Fundación Universitaria de Ciencias de la Salud, Bogotá DC, Colombia.

Guillermo Sánchez, Fundación Universitaria Ciencias de la Salud

Epidemiología, División de Investigaciones. Fundación Universitaria de Ciencias de la Salud. Bogotá DC. Colombia.

Ingrid Arévalo, Hospital Universitario Ramón y Cajal

Unidad de Bioestadística Clínica, Hospital Universitario Ramón y Cajal - IRYCIS, CIBER de Epidemiologia y Salud Publica, Madrid - España.

Javier Zamora, Hospital Universitario Ramón y Cajal

Unidad de Bioestadística Clínica, Hospital Universitario Ramón y Cajal - IRYCIS, CIBER de Epidemiologia y Salud Publica, Madrid - España.

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