USE OF INFLAMMATORY AND MOLECULAR BIOMARKERS IN THE EARLY DIAGNOSTIC ASSESSMENT OF SEPSIS IN CRITICALLY ILL PATIENTS: LIMITS, ADVANCES, AND CLINICAL PERSPECTIVES
DOI:
https://doi.org/10.36557/2009-3578.2025v11n2p8163-8176Palavras-chave:
Sepsis; Inflammatory biomarkers; Molecular biomarkers; Intensive care.Resumo
Sepsis remains one of the most challenging syndromes in intensive care, marked by marked clinical heterogeneity, rapid hemodynamic deterioration, and high mortality. Traditional diagnostic approaches, based on clinical scores (SIRS, qSOFA, SOFA) and microbiological methods, frequently identify sepsis only after significant organ dysfunction is established and are limited by delayed results, false negatives, and the impact of prior antibiotic exposure. In this context, inflammatory and molecular biomarkers have emerged as promising tools to support earlier diagnostic approximation, risk stratification, and therapeutic decision-making in critically ill patients. This narrative review aimed to analyze the main inflammatory and molecular biomarkers used in the diagnostic approximation of sepsis in adult intensive care patients, discussing their accuracy, clinical applicability, and prognostic implications. The review was guided by the PICo strategy (Population, Interest, Context) and included original studies, systematic and narrative reviews, clinical trials, observational research, and translational investigations published between 2015 and 2025 in PubMed, Scopus, Web of Science, and SciELO, in Portuguese, English, and Spanish. The findings highlight that classical inflammatory biomarkers, such as C-reactive protein, procalcitonin, IL-6, and TNF-α, play a consolidated role in monitoring systemic inflammation, differentiating infectious from non-infectious processes, and supporting antimicrobial stewardship. Emerging molecular biomarkers, particularly presepsin and sTREM-1, together with transcriptomic, proteomic, and metabolomic approaches, expand the understanding of sepsis endotypes and suggest pathways toward precision intensive care. However, the lack of standardization, methodological variability, costs, and limited availability restrict their widespread implementation. Overall, biomarkers should be interpreted as complementary tools-integrated with clinical, hemodynamic, and microbiological assessment- to reduce diagnostic uncertainty and enable earlier, more individualized interventions in patients with sepsis.
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Copyright (c) 2025 Maria Rielli Ciambelli Netta, Yasmin Salim Veronez, Samara Zumba Flores, Ana Raquel de Almeida Goto, Sophia Evaristo Coércio, Diego da Silva Marques, João Felipi Fernandes Riguette, Elisângela Aparecida Cóis Ferreira, Camila Menon Oliveros, Laura Moreira Montanhini, Maria Vitoria Berti Carnelozzi, Mariana Valenhes dos Santos, Mara Flávia Mamédio Avallone, Cristiano Machado Galhardi, Rodolfo de Oliveira Medeiros
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