Biomarker Applications in Sepsis Management and Diagnosis

Sepsis arises from a dysregulated host response to infection and remains a leading cause of mortality worldwide. Early recognition and risk stratification are imperative to guide timely intervention, yet clinical signs and conventional laboratory tests often lack specificity or sensitivity. Biomarkers—molecular indicators of physiological or pathological processes—have emerged as pivotal tools to improve diagnosis, monitor disease progression and tailor therapeutic strategies. Established markers such as procalcitonin and C-reactive protein have proven useful for distinguishing bacterial sepsis from non-infectious inflammation and for guiding antibiotic stewardship, but their performance is limited by intercurrent comorbidities and variable kinetics. Recent efforts have focused on novel indicators of endothelial injury, immune activation and organ dysfunction, alongside multiplexed and point-of-care platforms, to deliver rapid, precise and personalised information. Integrating mechanistic insights with translational technologies promises to refine sepsis management, reduce unnecessary interventions and improve outcomes across diverse clinical settings.

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Biomarker Applications in Sepsis Management and Diagnosis publication trend

The graph below shows the total number of articles in biomarker applications in sepsis management and diagnosis across all publications each year (not limited to Nature Index journals).

Technical terms

Biomarker: A measurable molecule indicating normal or pathological processes, or pharmacological responses to a therapeutic intervention.

Procalcitonin (PCT): A precursor of calcitonin released in response to bacterial infection, used to differentiate sepsis from non-infectious inflammation.

Presepsin: The soluble CD14 subtype released upon monocyte activation, proposed as an early indicator of bacterial sepsis.

Heparin-binding protein (HBP): A neutrophil-derived mediator that increases vascular permeability and reflects endothelial activation.

Neutrophil gelatinase-associated lipocalin (NGAL): A marker of renal tubular injury often elevated in acute kidney injury.

Galectin-3: A carbohydrate-binding lectin implicated in inflammation and fibrosis, emerging as a prognostic marker in sepsis.

Soluble suppression of tumourigenicity 2 (sST2): A decoy receptor for interleukin 33, indicative of cardiac stress and immune dysregulation.

Mendelian randomisation: A genetic epidemiology method that uses genetic variants to assess causal relationships between biomarkers and clinical outcomes.

References

1. TLR4-mediated release of heparin-binding protein in human airways: a co-stimulatory role for IL-26. Frontiers in Immunology (2023).
2. Relationship between low molecular weight heparin calcium therapy and prognosis in severe acute kidney injury in sepsis: Mendelian randomized analysis and retrospective study. Frontiers in Pharmacology (2024).
3. Multi-marker approach using procalcitonin, presepsin, galectin-3, and soluble suppression of tumorigenicity 2 for the prediction of mortality in sepsis. Annals of Intensive Care (2017).
4. Comparison of diagnostic accuracy in sepsis between presepsin, procalcitonin, and C-reactive protein: a systematic review and meta-analysis. Annals of Intensive Care (2017).