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Advances in Sepsis: Pathogenesis, Biomarkers, Treatments and Prognosis

A special issue of International Journal of Molecular Sciences (ISSN 1422-0067). This special issue belongs to the section "Molecular Pathology, Diagnostics, and Therapeutics".

Deadline for manuscript submissions: 20 October 2025 | Viewed by 1194

Special Issue Editor


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Guest Editor
High-Dependency Unit, Department of Clinical and Experimental Medicine, Azienda Ospedaliero Universitaria Careggi, Lg. Brambilla 3, 50134 Firenze, Italy
Interests: sepsis; sepsis-induced cardiomyopathy; sepsis treatment; non-invasive ventilation; simulation; education

Special Issue Information

Dear Colleagues,

I am delighted to present this new IJMS Special Issue, collecting new developments in sepsis diagnosis and treatment.

In 2024, we are still discussing sepsis, even though we all know that it is not a single disease. Indeed, previous comorbidities, infection sources, and causative pathogens influence its development, evolution, and response to treatment, as well as the final prognosis. We need to improve our ability to characterize septic patients from several points of view.

First, we must learn to better recognize sepsis early to prompt the best treatment. New feasible and reliable biomarkers need to be validated with robust scientific evidence. It is also urgent to find the correct and meaningful application of new technologies for early bacterial identification. This would help us reduce the employment of empiric antibiotic treatments, a cornerstone in the fight against the growing spectrum of antimicrobial resistance. Similarly, we must overcome the “one-size-fits-all” approach that has guided the early resuscitation of septic patients until now. Meanwhile, an inadequate selection of study populations might explain the non-significant results obtained by several studies, which evaluated novel regimens of fluid administration or vasopressor dosing and timing without ascertaining whether the right patient was assigned to the right study arm. Improved characterization will translate into better prognostic assessment and early identification of patients at high risk of an adverse prognosis.

Importantly, contributions should focus on some molecular aspects but must not include only pure clinical research.

Dr. Francesca Innocenti
Guest Editor

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Keywords

  • sepsis phenotypes
  • hemodynamic stabilization
  • fluids
  • vasopressors
  • diagnostic biomarkers
  • tailored approach
  • immune modulation
  • immunomodulatory therapy
  • prognostic stratification

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Published Papers (2 papers)

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Research

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11 pages, 349 KiB  
Article
Sepsis Prediction: Biomarkers Combined in a Bayesian Approach
by João V. B. Cabral, Maria M. B. M. da Silveira, Wilma T. F. Vasconcelos, Amanda T. Xavier, Fábio H. P. C. de Oliveira, Thaysa M. G. A. L. de Menezes, Keylla T. F. Barbosa, Thaisa R. Figueiredo, Jabiael C. da Silva Filho, Tamara Silva, Leuridan C. Torres, Dário C. Sobral Filho and Dinaldo C. de Oliveira
Int. J. Mol. Sci. 2025, 26(15), 7379; https://doi.org/10.3390/ijms26157379 - 30 Jul 2025
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Abstract
Sepsis is a serious public health problem. sTREM-1 is a marker of inflammatory and infectious processes that has the potential to become a useful tool for predicting the evolution of sepsis. A prediction model for sepsis was constructed by combining sTREM-1, CRP, and [...] Read more.
Sepsis is a serious public health problem. sTREM-1 is a marker of inflammatory and infectious processes that has the potential to become a useful tool for predicting the evolution of sepsis. A prediction model for sepsis was constructed by combining sTREM-1, CRP, and a leukogram via a Bayesian network. A translational study carried out with 32 children with congenital heart disease who had undergone surgical correction at a public referral hospital in Northeast Brazil. In the postoperative period, the mean value of sTREM-1 was greater among patients diagnosed with sepsis than among those not diagnosed with sepsis (394.58 pg/mL versus 239.93 pg/mL, p < 0.001). Analysis of the ROC curve for sTREM-1 and sepsis revealed that the area under the curve was 0.761, with a 95% CI (0.587–0.935) and p = 0.013. With the Bayesian model, we found that a 100% probability of sepsis was related to postoperative blood concentrations of CRP above 71 mg/dL, a leukogram above 14,000 cells/μL, and sTREM-1 concentrations above the cutoff point (283.53 pg/mL). The proposed model using the Bayesian network approach with the combination of CRP, leukocyte count, and postoperative sTREM-1 showed promise for the diagnosis of sepsis. Full article
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18 pages, 1491 KiB  
Review
Monocyte Distribution Width for Sepsis Diagnosis in the Emergency Department and Intensive Care Unit: A Systematic Review and Meta-Analysis
by Jessica Elisabetta Esposito, Milena D’Amato, Giustino Parruti and Ennio Polilli
Int. J. Mol. Sci. 2025, 26(15), 7444; https://doi.org/10.3390/ijms26157444 - 1 Aug 2025
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Abstract
We planned a systemic review and meta-analysis to evaluate the diagnostic accuracy of Monocyte Distribution Width (MDW) in aiding the diagnosis of sepsis in the Emergency Department (ED) and Intensive Care Unit (ICU). A systematic literature search was performed in PubMed, Scopus, and [...] Read more.
We planned a systemic review and meta-analysis to evaluate the diagnostic accuracy of Monocyte Distribution Width (MDW) in aiding the diagnosis of sepsis in the Emergency Department (ED) and Intensive Care Unit (ICU). A systematic literature search was performed in PubMed, Scopus, and OVID to retrieve studies published up to 29 January 2024. We examined results using mean difference and conducted a diagnostic test accuracy (DTA) meta-analysis using a bivariate random effects model. Pooled results showed that MDW was significantly higher in sepsis patients admitted to the ED (MD = 5.59, 95%CI: 4.14–7.05) or to the ICU (MD = 8.30, 95%CI: 2.98–13.62). Nine studies conducted in the ED were included in the DTA review. The overall sensitivity was 0.80 (95%CI: 0.75–0.85), the specificity was 0.76 (95%CI: 0.66–0.83), and the false-positive rate (FPR) was 0.24 (95%CI: 0.17–0.34). Three studies were conducted in the ICU, but only two were included in the DTA meta-analysis. Of the 662 patients admitted to the ICU, 175 developed sepsis, showing higher MDW values than non-septic patients. However, significant heterogeneity was noted among the studies. MDW is a helpful biomarker for sepsis in adult patients admitted to the ED and ICU. In the ED, MDW could aid clinicians in ruling out sepsis. Full article
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