49 Biomarkers in sepsis Future perspectives The clinical use of biomarkers in sepsis is still at its infancy, especially when compared with other fields such as vascular medicine and oncology. Thus far biomarker research in sepsis has primarily focused on discrimination between infectious and non-infectious causes of critical illness, and sepsis prognosis. Biomarkers can likely also be used to stratify patients with sepsis according to biochemical and/or immunological profiles, which can provide insight into the main pathophysiological mechanisms in individual patients and in pathways that can potentially be targeted. New “omics” technologies can be of great help herein, associating expression at RNA, protein and metabolite levels with specific complications and outcomes. The challenge will be to develop biomarker sets that can be measured in simply obtainable samples such as blood and urine, and yet mirror pathophysiological events at different body sites. Such biomarker sets could guide inclusion of patients who might benefit from a targeted therapy and monitor the effect of the therapeutic on its target using an approach that has been named theranostics. We foresee a future for sepsis management in which therapies are guided by repeated measurements of biomarker sets reflecting aberrations in host response pathways that can be specifically modified by targeted therapeutics, using rapid bedside tests with limited hands-on time and no need for specialized laboratories. In this personalized medicine approach individualized therapies would be provided in a pathology-specific way, and not purely based on clinical presentation. 3
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