Distinct host-response signatures in circulatory shock: a narrative review

Circulatory shock is defined syndromically as hypotension associated with tissue hypoperfusion and often subcategorized according to hemodynamic profile (e.g., distributive, cardiogenic, hypovolemic) and etiology (e.g., infection, myocardial infarction, trauma, among others). These shock subgroups a...

Full description

Saved in:
Bibliographic Details
Published in:Intensive care medicine experimental 2023-08, Vol.11 (1), p.50-50, Article 50
Main Authors: Soussi, Sabri, dos Santos, Claudia, Jentzer, Jacob C., Mebazaa, Alexandre, Gayat, Etienne, Pöss, Janine, Schaubroeck, Hannah, Billia, Filio, Marshall, John C., Lawler, Patrick R.
Format: Article
Language:English
Subjects:
Biomarkers
Critical Care Medicine
Hemodynamics
Hypotension
Intensive
Intensive care
Medicine
Medicine & Public Health
Pathophysiology
Reviews
Shock (Circulatory)
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:Circulatory shock is defined syndromically as hypotension associated with tissue hypoperfusion and often subcategorized according to hemodynamic profile (e.g., distributive, cardiogenic, hypovolemic) and etiology (e.g., infection, myocardial infarction, trauma, among others). These shock subgroups are generally considered homogeneous entities in research and clinical practice. This current definition fails to consider the complex pathophysiology of shock and the influence of patient heterogeneity. Recent translational evidence highlights previously under-appreciated heterogeneity regarding the underlying pathways with distinct host-response patterns in circulatory shock syndromes. This heterogeneity may confound the interpretation of trial results as a given treatment may preferentially impact distinct subgroups. Re-analyzing results of major ‘neutral’ treatment trials from the perspective of biological mechanisms (i.e., host-response signatures) may reveal treatment effects in subgroups of patients that share treatable traits (i.e., specific biological signatures that portend a predictable response to a given treatment). In this review, we discuss the emerging literature suggesting the existence of distinct biomarker-based host-response patterns of circulatory shock syndrome independent of etiology or hemodynamic profile. We further review responses to newly prescribed treatments in the intensive care unit designed to personalize treatments (biomarker-driven or endotype-driven patient selection in support of future clinical trials).
ISSN:2197-425X
2197-425X
DOI:10.1186/s40635-023-00531-5