Biomarqueurs des états septiques sévères : vers de nouvelles stratégies thérapeutiques individualisées

Abstract : Septic syndromes remain the leading cause of death in the intensive care units despite numerous clinical trials. Septic patients constitute a very heterogeneous population. Therefore improved characterisation of patients in order to better target and personalize potential new therapeutics is highly desirable. A multiparametric biomarker-based approach could be an attractive alternative to obtain a global view of the pathophysiologic situation. In this context, we worked specifically on cardio-vascular and immune dysfunctions. We first confirmed the predictive value of biomarkers for mortality or nosocomial infections, and showed new elements. We observed that (1) PD-1 overexpression is associated with leukocyte anergy, (2) one biomarker could give different information over time, (3) information provided by the association of two biomarkers is more interesting than the addition of their individual values, and (4) dynamic expression of one biomarker is more informative than its expression at a given time point. Finally, our results illustrate the potential interest of biomarker panels to improve our understanding of the septic syndrome complexity and to reflect their rapid evolution. Consequently, next step will depend on our capacity to develop biostatistic tools that enable clinicians to get, in real time, a global view of the process over time. This key step is likely necessary to decrease the heterogeneity of septic patient population in order to better stratify and target next clinical trials in the field.
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Caroline Guignant. Biomarqueurs des états septiques sévères : vers de nouvelles stratégies thérapeutiques individualisées. Sciences agricoles. Université Claude Bernard - Lyon I, 2011. Français. ⟨NNT : 2011LYO10319⟩. ⟨tel-00744932⟩

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