Recommendations for the use of biomarkers for the management of adults with sepsis: a scoping review

Abstract

Background Biomarkers are invaluable tools for clinicians to optimise patient care at the bedside. The information derived from clinical guidelines plays a pivotal role in establishing evidence-based practices. However, a synthesis and appraisal of the recommendations for the use of biomarkers in adults with sepsis is lacking. Our aim is to identify, describe and display in an Evidence Gap Map (EGM) the clinical guidelines with recommendations on the use of biomarkers for the management of adults with sepsis. Methods and findings : This is a scoping review. We searched for guidance documents (GD) in Medline, Guidelines International Network, Pan American Health Organization, Trip Database and UpToDate from 2016 to July 2022. Two reviewers independently applied the eligibility criteria and extracted data. We used the Appraisal of Guidelines for Research and Evaluation-II (AGREE II) tool to assess the quality of the included documents. We displayed the recommendations in an EGM. We found eight GD, mostly oriented for the general population (75.0%). Only half of these documents had a robust methodology (scored above 50.0% in the AGREE II 'Rigour of development' domain). We extracted 28 recommendations from these GD, of which 17 (60.7%) were developed using GRADE. The recommendations targeted a total of five biomarkers, with 25 (89.2%) recommendations focused on a single biomarker. Lactate and procalcitonin were the most frequent, mainly for prognostic purposes (85.8%) and treatment monitoring (46.4%). Most recommendations pointed to using the biomarker (85.7%) with a strength graded as strong (14/28; 50.0%) or conditional (12/28; 42.8%). Conclusions This scoping review identified and evaluated the GD and the recommendations on using biomarkers for managing adults with sepsis. A robust methodology was observed in a few GD. The consistency of the recommendations was low, and only a few biomarkers, such as lactate and procalcitonin, were addressed, mostly for prognosis. The role of the biomarkers for sepsis needs to be better evaluated. Moreover, enhancing the methodological quality of guideline development is essential to generate more valid and robust recommendations, which could significantly contribute to the optimization of patient care.