Potential biomarkers in septic shock besides lactate

Area of Science:

• Biochemistry
• Critical Care Medicine
• Metabolic Research

Background:

• Elevated lactate is a common septic shock biomarker, guiding resuscitation.
• Persistent hyperlactatemia may stem from causes beyond isolated hypoxia.
• Energy metabolism offers novel insights into septic shock pathophysiology.

Purpose of the Study:

• To review potential septic shock biomarkers focusing on energy metabolism.
• To explore the role of TCA cycle intermediates, NAD+/NADH ratio, and malate dehydrogenase (MDH).
• To propose a novel combined biomarker strategy for septic shock.

Main Methods:

• Literature review of energy metabolism in septic shock.
• Analysis of biomarkers including lactate, malate-aspartate shuttle (MAS) components, NAD+/NADH ratio, and MDH.
• Evaluation of the proposed lactate and MDH combination for clinical feasibility.

Main Results:

• Persistent hyperlactatemia in septic shock is not solely indicative of hypoxia.
• Malate dehydrogenase (MDH) participates in both MAS and TCA cycle for ATP generation.
• A combination of lactate and MDH is proposed as a more comprehensive biomarker for septic shock.

Conclusions:

• Energy metabolism offers a new perspective on septic shock biomarkers.
• The combination of lactate and MDH may provide a more accurate reflection of hypoxia in septic shock.
• Further research is needed to validate the clinical utility of the proposed lactate-MDH biomarker combination.