Precision medicine and enrichment in sepsis

Abstract

Sepsis is defined as a dysregulated host response to infection leading to life-threatening organ dysfunction. While this recent iteration of the sepsis definition rightly centralizes organ dysfunction, it does not reflect on the extensive heterogeneity in the host response observed in sepsis patient populations. Heterogeneity in sepsis has hindered the identification of effective therapeutic targets, with current treatment consisting of antimicrobials and supportive care. In order to address the shortcomings in identifying specific therapeutics for sepsis, the focus of various research activities turned towards developing precision medicine approaches. In particular, efforts aimed at stratifying patients into more homogenous subgroups having common dominant pathophysiological features and outcome trajectories, in turn facilitating the delineation of specific therapies. Here, I review current initiatives in prognostic and predictive enrichment strategies in sepsis patient populations, which will be key to identify patients who would benefit, or be harmed, from specific therapeutic interventions.