Biomarkers predicting sepsis in polytrauma patients: Current evidence

Introduction: 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. Aim: 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 biomarker 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 posttraumatic 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. Conclusion: 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. (C) 2013 Elsevier Ltd. All rights reserved.