New septic shock biomarker Dx could produce better care and smoother drug trials

A new diagnostic test developed by Ohio researchers and their colleagues screens for 5 protein biomarkers that can help differentiate septic shock patients at high or low risk for death. If further testing supports the initial findings, doctors will gain a tool to help them determine which patients need experimental therapies and which should get more traditional treatment.

Scientists at the Cincinnati Children's Hospital Medical Center and the University of Cincinnati developed the blood test and diagnostic tool, and their findings are detailed in the April edition of Critical Care Medicine.

The National Institutes of Health describes septic shock as a serious condition that occurs when the body faces an overwhelming infection and then develops low blood pressure that is life threatening. The condition can lead to inflammation and harm organs crucial to survival. Septic shock can evolve drastically, and so a new test to improve how patients are screened could really help boost the standard of care. 

While more research is needed, the scientists believe their study (funded by the NIH and others) will ultimately help doctors identify patients sooner who need more radical treatment and also zero in on specific treatments that might help. Three of the 5 biomarkers that helped specify septic shock risks in patients for the study also worked for stratifying children. With that in mind, the idea is that there is some consistency in the biomarkers that could also give drugmakers reliable targets for treatment.

For their study, the research team followed more than 880 adults in intensive care units in medical centers based in the U.S., Finland and Canada. The 5 biomarkers were chosen based on their clear links to infection and inflammation. Beyond the blood test, their diagnostic "tool" also included a mathematical model that combined measurements of a patient's age, lactate levels and the number of chronic diseases in a given patient. The goal was to differentiate between septic shock patients at high or low risk of death.

The researchers found that the tool worked well enough to conclude that patients who tested as high risk faced survival odds under 50%. Patients who tested as low risk enjoyed survival odds, by contrast, of more than 90%. Interestingly, the researchers said the test worked well in different groups of patients and already performed better than the Acute Physiology and Chronic Health Evaluation test, which relies more on measurements such as blood pressure than blood tests.

"Substantial resources are invested in trying to find new treatments for septic shock, but the vast majority of them fail when they get to clinical trials," lead investigator Dr. Hector Wong said in a statement.

"There are many reasons for this," added Wong, director of critical care medicine at Cincinnati Children's, "but a consistent one is that the baseline mortality risk varies widely in septic shock patients, which muddies the water."

Having a test that could screen patients in greater detail would counter this issue and potentially benefit everything from overall patient care to trials for septic shock drugs, the researchers said.

- read the release
- here's the journal abstract

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