Table 1.
Biomarkers with potential application in sepsis or septic shock.
| Immunological Biomarkers | |
|---|---|
| C-reactive protein (CRP) | Indicates acute systemic inflammation [38] Screening for early onset neonatal sepsis [39] (Predict survival in patients with sepsis) [40] |
| Procalcitonin (PCT) | Diagnosis of sepsis [41,42] Suggest bacterial infection [43] Monitor treatment response to antibiotics and guide cessation of antibiotic treatment [44,45,46,47] |
| Presepsin (soluble CD14) | Early detection of sepsis (earlier increase than PCT and CRP) [48] Monitor host response [49] Higher in patients with bacterial infection [50] May be combined with other biomarkers in a panel [51] No validity in patients with acute kidney injury [52] |
| Interleukin-6 (IL-6) | Early detection of sepsis [53,54] Early detection of SIRS [55] Differentiate infectious from sterile SIRS [56] |
| Interleukin-8 (IL-8) | Diagnosis of sepsis [57] |
| CD64 expression on neutrophils (nCD64) | Early detection of sepsis [58,59,60,61,62,63,64] (monitoring of sepsis) [63,65] Prognostic marker of sepsis [66,67] |
| Soluble programmed death ligand 1 (sPD-L1) | Detect immunosuppressed states in sepsis patients [68,69] Potential therapeutic target [70] |
| HLA-DR expression on antigen-presenting cells | High HLA-DR expression: Detect hyperinflammatory state [71] Low HLA-DR expression: Detect immunosuppressed state [72] Predict poor survival in patients with septic shock [73] Potential biomarker for enrichment of clinical trials of sepsis [74] |
| Pentraxin (PTX-3) | Assessment of septic shock severity [75,76] Prediction of mortality in patients with sepsis or septic shock [77] |
| Complement protein 5a (C5a) | Limited utility in sepsis due to both pro- and anti-inflammatory effects [78,79] |
| Infectious biomarkers | |
| Lipopolysaccharide-binding protein (LPS-bp) | Discriminate sterile from infectious basis of SIRS or sepsis [80] |
| Pathogen-associated molecular patterns (PAMPs) | Early detection of pathogen-based immune stimuli [81,82,83,84] |
| Biomarkers of endothelial or glycocalyx dysfunction | |
| Syndecan-1 | Assessment of endothelial barrier dysfunction in sepsis [85] Predict organ failure due to endothelial dysfunction [86] Prediction of DIC or coagulatory dysfunction in sepsis-associated endothelial dysfunction [87,88,89] (May be helpful to guide fluid resuscitation in early sepsis) [90] |
| Adrenomedullin (ADM) | s. below (use case no. 2) |
| Angiopoietin-1, -2 | Detect fluid overload and endothelial leakage in sepsis [91,92] Predict septic shock [93] |
| Thrombomodulin | Predict multi organ failure and DIC in sepsis [94,95] |
| Heparanase-1 and -2 (Hpa-1, Hpa-2) | May identify septic patients with potential benefit from therapeutic plasma exchange therapy [96] Potential therapeutic target [97,98] |