From Promise to Practice: Barriers to the Clinical Implementation of Sepsis Biomarkers

Abstract

Sepsis biomarkers are often discussed as a single category, but the barriers to their clinical use differ by marker. Lactate is inexpensive and already embedded in the first-hour resuscitation bundle. Procalcitonin (PCT) has diffused into some health systems but not others, guided in part by a 2024 consensus statement on its implementation across South and South-East Asia and India; yet the 2024–2025 UK ADAPT-Sepsis trial, involving 2,760 patients across 41 intensive care units, found that PCT-guided care shortened mean antibiotic duration by less than one day, with protocol adherence below 50% and no mortality benefit. Host-response and transcriptomic markers remain confined to research settings for want of comparable outcome trials, not primarily for want of funding. At the author's own tertiary-level hospital in Mirpur Mathelo, Sindh, Pakistan, procalcitonin, lactate, and host-response assays are unavailable; only C-reactive protein and erythrocyte sedimentation rate are in routine use, and no laboratory staff are trained to run specialized sepsis assays. Cost and workforce absence, not standardization, are the binding constraints locally. Implementation should proceed marker by marker, weigh outcome evidence honestly, and engage concrete instruments such as the WHO Essential Diagnostics List.