title: Biomarkers predicting sepsis in polytrauma patients: Current evidence.
abstract: BACKGROUND
  Major trauma still represents one of the leading causes of death in the first four decades of life. Septic complications represent the predominant causes of late death (45% of overall mortality) in polytrauma patients. The ability of clinicians to early differentiate between systemic inflammatory response syndrome (SIRS) and sepsis is demonstrated to improve clinical outcome and mortality. The identification of an "ideal" biomarker able to early recognize incoming septic complications in trauma patients is still a challenge for researchers.
  
  
  OBJECTIVE
  To evaluate the existing evidence regarding the role of biomarkers to predict or facilitate early diagnosis of sepsis in trauma patients, trying to compile some recommendations for the clinical setting.
  
  
  METHODS
  An Internet-based search of the MEDLINE, EMBASE and Cochrane Library databases was performed using the search terms: "Biomarkers", "Sepsis" and "Trauma" in various combinations. The methodological quality of the included studies was assessed using the Quality Assessment of Diagnostic Accuracy Studies Checklist (QUADAS). After data extraction, the level of evidence available for each bio-marker was rated and presented using the "best-evidence synthesis" method, in line with the US Agency for Healthcare Research and Quality.
  
  
  RESULTS
  Thirty studies were eligible for the final analysis: 13 case-control studies and 17 cohort studies. The "strong evidence" available demonstrated the potential use of procalcitonin as an early indicator of post-traumatic septic complications and reported the inability of c-reactive protein (CRP) to specifically identify infective complications. Moderate, conflicting and limited evidence are available for the other 31 biomarkers.
  
  
  CONCLUSIONS
  Several biomarkers have been evaluated for predicting or making early diagnosis of sepsis in trauma patients. Current evidence does not support the use of a single biomarker in diagnosing sepsis. However, procalcitonin trend was found to be useful in early identification of post-traumatic septic course and its use is suggested (Recommendation Grade: B) in clinical practice.
authors.affiliation: Academic Department of Trauma & Orthopaedic Surgery, Clarendon Wing, Floor A, Great George Street, Leeds General Infirmary, LS1 3EX Leeds, UK.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Ciriello
authors.forename: Suribabu
authors.initials: S
authors.lastname: Gudipati
authors.forename: Petros Z
authors.initials: PZ
authors.lastname: Stavrou
authors.forename: Nikolaos K
authors.initials: NK
authors.lastname: Kanakaris
authors.forename: Mark C
authors.initials: MC
authors.lastname: Bellamy
authors.forename: Peter V
authors.initials: PV
authors.lastname: Giannoudis
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood*; D002116:Calcitonin; D015740:Calcitonin Gene-Related Peptide; D003937:Diagnosis, Differential; D003955:Diagnostic Tests, Routine; D005260:Female; D006801:Humans; D007249:Inflammation / Q000097:blood / Q000175:diagnosis* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000097:blood / Q000150:complications / Q000401:mortality; D011498:Protein Precursors; D018805:Sepsis / Q000097:blood / Q000175:diagnosis* / Q000401:mortality; D014481:United States; D055815:Young Adult
chemical_list: D015415:Biomarkers; C000606589:CALCA protein, human; D011498:Protein Precursors; D002116:Calcitonin; D015740:Calcitonin Gene-Related Peptide
keywords: Biomarkers; IL-6; Polytrauma; Procalcitonin; Recommendations; Sepsis