title: Do sepsis biomarkers in the emergency room allow transition from bundled sepsis care to personalized patient care?
abstract: OBJECTIVE
  There is convincing evidence linking early start of fluid resuscitation and initiation of appropriate antimicrobial therapy to improved outcomes in patients with sepsis in the emergency department. Blood biomarkers measured on admission and during follow-up have the ability to guide early sepsis recognition, severity assessment and therapeutic decisions in individual patients and may allow transition from bundled sepsis care to more individualized management in single patients.
  
  
  RESULTS
  Although a large number of promising diagnostic and prognostic biomarkers have been put forward in observational studies, only few have been evaluated in prospective randomized-controlled intervention trials. Markers such as lactate for risk stratification and guidance of fluid resuscitation, procalcitonin for assessing risk of bacterial infections and guiding therapeutic decisions about initiation and duration of antimicrobial therapy, and recently proadrenomedullin for early mortality prediction and site-of-care decisions in respiratory infections, have shown to improve patient management.
  
  
  CONCLUSIONS
  For few biomarkers, recent study results demonstrate that well defined clinical protocols have the potential to guide decisions about the individual risk stratification and treatment of patients with suspicion of sepsis ultimately leading to improved patient care and outcomes. For other biomarkers, promising observation data have been put forward, but their potential needs to be evaluated in large-scale, well designed prospective intervention studies before clinical use can be recommended.
authors.affiliation: Department of Internal Medicine, Kantonsspital Aarau, Switzerland. Philipp.Schuetz@unibas.ch
authors.forename: Philipp
authors.initials: P
authors.lastname: Schuetz
authors.forename: Sebastian
authors.initials: S
authors.lastname: Haubitz
authors.forename: Beat
authors.initials: B
authors.lastname: Mueller
mesh_terms: D053607:Adrenomedullin / Q000097:blood; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D015415:Biomarkers / Q000032:analysis* / Q000097:blood; D002116:Calcitonin / Q000097:blood; D015740:Calcitonin Gene-Related Peptide; D004636:Emergency Service, Hospital; D006801:Humans; D007362:Intensive Care Units; D005791:Patient Care; D017410:Practice Guidelines as Topic; D011379:Prognosis; D011498:Protein Precursors / Q000097:blood; D018570:Risk Assessment; D018805:Sepsis / Q000175:diagnosis* / Q000188:drug therapy
chemical_list: D000900:Anti-Bacterial Agents; D015415:Biomarkers; C000606589:CALCA protein, human; D011498:Protein Precursors; D053607:Adrenomedullin; D002116:Calcitonin; D015740:Calcitonin Gene-Related Peptide