Distinct host-response signatures in circulatory shock: a narrative review
Abstract 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 su...
| Main Authors: | , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
SpringerOpen
2023-08-01
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| Series: | Intensive Care Medicine Experimental |
| Online Access: | https://doi.org/10.1186/s40635-023-00531-5 |
| _version_ | 1797740697891110912 |
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| author | Sabri Soussi Claudia dos Santos Jacob C. Jentzer Alexandre Mebazaa Etienne Gayat Janine Pöss Hannah Schaubroeck Filio Billia John C. Marshall Patrick R. Lawler |
| author_facet | Sabri Soussi Claudia dos Santos Jacob C. Jentzer Alexandre Mebazaa Etienne Gayat Janine Pöss Hannah Schaubroeck Filio Billia John C. Marshall Patrick R. Lawler |
| author_sort | Sabri Soussi |
| collection | DOAJ |
| description | Abstract 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). |
| first_indexed | 2024-03-12T14:16:08Z |
| format | Article |
| id | doaj.art-0fc7c390b1824d438226e300f9975299 |
| institution | Directory Open Access Journal |
| issn | 2197-425X |
| language | English |
| last_indexed | 2024-03-12T14:16:08Z |
| publishDate | 2023-08-01 |
| publisher | SpringerOpen |
| record_format | Article |
| series | Intensive Care Medicine Experimental |
| spelling | doaj.art-0fc7c390b1824d438226e300f99752992023-08-20T11:02:51ZengSpringerOpenIntensive Care Medicine Experimental2197-425X2023-08-0111111210.1186/s40635-023-00531-5Distinct host-response signatures in circulatory shock: a narrative reviewSabri Soussi0Claudia dos Santos1Jacob C. Jentzer2Alexandre Mebazaa3Etienne Gayat4Janine Pöss5Hannah Schaubroeck6Filio Billia7John C. Marshall8Patrick R. Lawler9Department of Anesthesia and Pain Management, University Health Network (UHN), Women’s College Hospital, University of Toronto, Toronto Western HospitalSt Michael’s Hospital, Keenan Research Centre for Biomedical Science and Institute of Medical Sciences, University of TorontoDepartment of Cardiovascular Medicine, Mayo Clinic RochesterDepartment of Anesthesiology, Critical Care, Lariboisière-Saint-Louis Hospitals, DMU Parabol, AP–HP Nord; Inserm UMR-S 942, Cardiovascular Markers in Stress Conditions (MASCOT), University of ParisDepartment of Anesthesiology, Critical Care, Lariboisière-Saint-Louis Hospitals, DMU Parabol, AP–HP Nord; Inserm UMR-S 942, Cardiovascular Markers in Stress Conditions (MASCOT), University of ParisDepartment of Internal Medicine/Cardiology, Heart Center Leipzig at the University of LeipzigDepartment of Intensive Care Medicine, Department of Internal Medicine and Pediatrics, Ghent University Hospital, Ghent UniversityPeter Munk Cardiac Centre, University Health Network, University of TorontoSt Michael’s Hospital, Keenan Research Centre for Biomedical Science and Institute of Medical Sciences, University of TorontoPeter Munk Cardiac Centre, University Health Network, University of TorontoAbstract 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).https://doi.org/10.1186/s40635-023-00531-5 |
| spellingShingle | Sabri Soussi Claudia dos Santos Jacob C. Jentzer Alexandre Mebazaa Etienne Gayat Janine Pöss Hannah Schaubroeck Filio Billia John C. Marshall Patrick R. Lawler Distinct host-response signatures in circulatory shock: a narrative review Intensive Care Medicine Experimental |
| title | Distinct host-response signatures in circulatory shock: a narrative review |
| title_full | Distinct host-response signatures in circulatory shock: a narrative review |
| title_fullStr | Distinct host-response signatures in circulatory shock: a narrative review |
| title_full_unstemmed | Distinct host-response signatures in circulatory shock: a narrative review |
| title_short | Distinct host-response signatures in circulatory shock: a narrative review |
| title_sort | distinct host response signatures in circulatory shock a narrative review |
| url | https://doi.org/10.1186/s40635-023-00531-5 |
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