Current Evidence and Limitation of Biomarkers for Detecting Sepsis and Systemic Infection

Area of Science:

• Clinical Medicine
• Infectious Diseases
• Biomarker Research

Background:

• Sepsis, a life-threatening organ dysfunction from infection, requires accurate diagnostic tools.
• Biomarkers are crucial for early sepsis detection, diagnosis, and prognosis.
• Several biomarkers, including CRP, PCT, IL-6, CD64, presepsin, and sTREM-1, are under investigation.

Purpose of the Study:

• To review and assess the diagnostic performance of six promising sepsis biomarkers.
• To identify limitations and risks of bias in existing studies evaluating these biomarkers.
• To provide recommendations for future research to enhance biomarker reliability.

Main Methods:

• Systematic review of studies on C-reactive protein (CRP), procalcitonin (PCT), interleukin-6 (IL-6), CD64, presepsin, and sTREM-1.
• Analysis of study designs, sampling strategies, and statistical methods used in the reviewed literature.
• Identification of common risks of bias, including sampling methods, cutoff value selection, and heterogeneity.

Main Results:

• Significant risks of bias were identified in current sepsis biomarker studies.
• Common issues include non-random sampling, case-control designs, post hoc cutoff values, small sample sizes, and heterogeneity.
• CD64 and presepsin emerged as the most promising biomarkers for sepsis diagnosis based on available evidence.

Conclusions:

• CD64 and presepsin warrant further investigation as reliable sepsis diagnostic biomarkers.
• Future studies should prioritize larger sample sizes, cohort designs, and standardized methodologies.
• Recommendations include pre-specified thresholds, consistent sampling, and adherence to updated sepsis definitions for improved reliability.