Marcadores moleculares en el diagnóstico y pronóstico de sepsis, sepsis grave y choque séptico

Introduction: Despite important progress in the understanding of the pathophysiology of sepsis, the mortality rates caused by this condition remain high. Objective: To describe the state of the art on molecular biomarkers proposed as potential markers for the diagnosis and prognosis of sepsis, severe sepsis and septic shock. Materials and methods: The terms sepsis, genetic polymorphisms, genetic variation and molecular marker were analyzed in the records of the last 14 years of PubMed, the New England Journal of Medicine ( NEJM ) and Illinois Automatic Computer ( ILLIAC ). The papers were classified by year of publication; only those published within the last 10 years were taken into account. Results: The search yielded 3390 references covering more than 30 genes with genetic polymorphisms that can be used as potential polymorphism markers. They were assessed for use in different manifestations, diagnosis and progression of sepsis. Twenty genetic markers are described: four associated with bacteremia (TLR-1, TLR-2, Protein C and Selectin-E), nine with sepsis (IL-1B, IL-1A, IL-6, TNF- α , TLR-1, MBL-1, Hsp70, PAI-1 and MIF-1), seven with severe sepsis (IL-1RN, IL-10, TNF- α , CD14, TREM-1, Caspase 12 and DEFB-1), five with septic shock (TNF-B, TLR-4, Hsp70, MBL-1 and CD14 ), and three with multiorgan dysfunction (TLR-1, PAI-1 and Protein C). Conclusion: In general, genetic polymorphisms have been clinically tested as diagnostic and prognostic markers of sepsis with promising results due to the high specificity and sensitivity of the clinical practice.