Biomarkers for intensive care medicine patients: the (stony) path into a bright future?

In intensive care units (ICUs), physicians and nursing auxiliary are confronted with a broad range of severe medical conditions, such as cardiac and respiratory disorders, viral and bacterial infections, severe bleedings, trauma and as a result of aforementioned situations (multiple-) organ dysfunction. Goldhill and Sumner (1998) reported that 23.8% of 12,762 patients admitted to 15 British ICUs died. Similar figures (26.6%) were reported from a prospective multicenter trial which included 873 ICU patients (Nfor et al. 2006). Moreover, many patients died after discharge from ICU. Post-ICU (in-hospital) mortality has been reported to be 7.3% as well as 17.9 or 27% (Goldhill & Sumner 1998, Latour et al. 1990, Rowan et al. 1993). Despite the tremendous progress achieved in the care for patients requiring intensive care over the last decades, such as by modern antibiotic therapy and mechanical ventilation, the overall mortality of ICU patients improved surprisingly little (Resche-Rigon et al. 2006). One reason for this phenomena may be a lack of differentiation with an oversimplifying approach applying the current “gold standard therapy” for all patients with a given diagnosis. Indeed, it is most likely that we are not fully recognizing the existing heterogeneity with regard to the current status within one disease and thus ignoring potential individual needs in a given situation. It may be postulated that a more personalized therapeutic approach should lead to better medical care and as a result to better prognosis of the critically ill patient. A prerequisites for such an individualized rational decision making are objective parameters and criteria enabling meaningful differentiation, with biomarkers being the key candidate for such strategies.