Journal of Diagnostics Concepts & Practice >
Advances in sepsis screening technologies
Received date: 2025-07-31
Revised date: 2025-10-15
Online published: 2025-12-25
Sepsis is a life-threatening syndrome of organ dysfunction caused by a dysregulated systemic inflammatory response to infection. Early recognition and precise intervention are crucial for improving the prognosis of sepsis patients. In recent years, significant progress has been made in technologies related to sepsis, such as etiological identification, host-response assessment, and intelligent-assisted diagnosis, enhancing the diagnosis and treatment capability of sepsis. This review provides a systematic overview of advances in etiological identification [such as rapid mass spectrometry identification of positive blood culture, metagenomic next-generation sequencing (mNGS), droplet digital polymerase chain reaction (ddPCR), and T2 magnetic resonance], the application of host-response monitoring markers [such as procalcitonin (PCT), interleukin-6 (IL-6), monocyte human leukocyte antigen-DR (mHLA-DR), and emerging non-coding RNAs] in infection recognition and immune monitoring, and the roles of multi-omics (transcriptomics, proteomics, and metabolomics) and artificial intelligence (AI) technologies in early warning, endotyping, and individualized therapy of sepsis. Additionally, this review highlights the current limitations of sepsis screening technologies, and outlines future directions for cross-disciplinary collaboration to promote precise screening and clinical translation.
LIU Gan , DAI Yuanyuan , CHANG Wenjiao , MA Xiaoling . Advances in sepsis screening technologies[J]. Journal of Diagnostics Concepts & Practice, 2025 , 24(06) : 567 -575 . DOI: 10.16150/j.1671-2870.2025.06.001
| [1] | GIAMARELLOS-BOURBOULIS E J, EUROPEAN SEPSIS A, ZINKERNAGEL A S, et al. Sepsis, a call for inclusion in the work plan of the European Center for Di-sease Prevention and Control[J]. Intensive Care Med, 2023, 49(9): 1138-1142. |
| [2] | RUDD K E, JOHNSON S C, AGESA K M, et al. Global, regional, and national sepsis incidence and mortality, 1990-2017: analysis for the Global Burden of Disease Study[J]. Lancet, 2020, 395(10219):200-211. |
| [3] | MORRISSEY R, LEE J, BARAL N, et al. Demographic and regional trends of sepsis mortality in the United States, 1999-2022[J]. BMC Infect Dis, 2025, 25(1):504. |
| [4] | WENG L, XU Y, YIN P, et al. National incidence and mortality of hospitalized sepsis in China[J]. Crit Care, 2023, 27(1):84. |
| [5] | DONG R, LIU W, WENG L, et al. Temporal trends of sepsis-related mortality in China, 2006-2020: a population-based study[J]. Ann Intensive Care, 2023, 13(1):71. |
| [6] | 付晶, 张瑞鹏, 许美馨, 等. 中国西南地区某大型三甲综合医院脓毒症住院患者的流行病学分析[J]. 中华危重病急救医学, 2024, 36(6):574-577. |
| FU J, ZHANG R P, XU M X, et al. Epidemiological analysis of in patients with sepsis in a large tertiary general hospital in Southwest China[J]. Chin Crit Care Med, 2024, 36(6):574-577. | |
| [7] | MILLER J M, BINNICKER M J, CAMPBELL S, et al. Guide to utilization of the microbiology laboratory for diagnosis of infectious diseases: 2024 update by the Infectious Diseases Society of America (IDSA) and the American Society for Microbiology (ASM)[J]. Clin Infect Dis, 2024. |
| [8] | RYDZAK T, GROVES R A, ZHANG R, et al. Metabolic preference assay for rapid diagnosis of bloodstream infections[J]. Nat Commun, 2022, 13(1):2332. |
| [9] | PHILIPPON A L, LEBAL S, CANCELLA DE ABREU M, et al. Association between time to antibiotic and mortality in patients with suspected sepsis in the emergency department: post hoc analysis of the 1-BED randomized clinical trial[J]. Eur J Emerg Med, 2025, 32(2):109-115. |
| [10] | LI Z, LIU S, CHEN H, et al. Comparative evaluation of BACTEC FX, BacT/ALERT 3D, and BacT/ALERT VIRTUO automated blood culture systems using simulated blood cultures[J]. Acta Clin Belg, 2022, 77(1):71-78. |
| [11] | FITTS E C, DENT E A, BURD E M. Validation of short culture method for rapid bacterial identification of blood cultures via matrix-assisted laser desorption/ionization time-of-flight mass spectrometry[J]. J Antimicrob Chemother, 2024, 79(12Suppl 2):i9-i12. |
| [12] | TSENG H Y, CHEN C L, CHEN W C, et al. Reduced mortality with antimicrobial stewardship guided by BioFire FilmArray Blood Culture Identification 2 panel in critically ill patients with bloodstream infection: A retrospective propensity score-matched study[J]. Int J Antimicrob Agents, 2024, 64(4):107300. |
| [13] | MAO J Y, LI D K, ZHANG D, et al. Utility of paired plasma and drainage fluid mNGS in diagnosing acute intra-abdominal infections with sepsis. BMC Infect Dis. 2024; 24(1):409. |
| [14] | PAN T J, LUO W W, ZHANG S S, et al. The clinical application value of multi-site mNGS detection of patients with sepsis in intensive care units[J]. BMC Infect Dis, 2024, 24(1):920. |
| [15] | XU F, CHEN C, LU S, et al. Impact of metagenomics next-generation sequencing on etiological diagnosis and early outcomes in sepsis[J]. J Transl Med, 2025, 23(1):394. |
| [16] | PENG J, BAI H, LI Y, et al. ddPCR enhances early diagnosis, treatment, prognosis, and pathogen verification in elderly BSI[J]. Front Cell Infect Microbiol, 2025, 15:1605795. |
| [17] | JIANG S, ZHAO D, WANG C, et al. Clinical evaluation of droplet digital PCR in the early identification of suspected sepsis patients in the emergency department: a prospective observational study[J]. Front Cell Infect Microbiol, 2024, 14:1358801. |
| [18] | LIN K, ZHAO Y, XU B, et al. Clinical diagnostic performance of droplet digital PCR for suspected bloodstream infections[J]. Microbiol Spectr, 2023, 11(1):e0137822. |
| [19] | KITAGAWA H, KOJIMA M, TADERA K, et al. Clinical diagnostic performance of droplet digital PCR for pathogen detection in patients with Escherichia coli bloodstream infection: a prospective observational study[J]. BMC Infect Dis, 2025, 25(1):22. |
| [20] | MYLONAKIS E, CLANCY C J, OSTROSKY-ZEICHNER L, et al. T2 magnetic resonance assay for the rapid diagnosis of candidemia in whole blood: a clinical trial[J]. Clin Infect Dis, 2015, 60(6):892-899. |
| [21] | BONURA C, GRACEFFA D, DISTEFANO S, et al. Evaluation of T 2 magnetic resonance (T2MR?) techno-logy for the early detection of ESKAPEc pathogens in septic patients[J]. Antibiotics (Basel), 2024, 13(9):885. |
| [22] | BOLANAKI M, WINNING J, SLAGMAN A, et al. Biomarkers improve diagnostics of sepsis in adult patients with suspected organ dysfunction based on the quick Sepsis-Related Organ Failure Assessment (qSOFA) score in the emergency department[J]. Crit Care Med, 2024, 52(6):887-899. |
| [23] | CHRISTENSEN E E, BINDE C, LEEGAARD M, et al. Diagnostic accuracy and added value of infection biomarkers in patients with possible sepsis in the emergency department[J]. Shock, 2022, 58(4):251-259. |
| [24] | MONNERET G, LAFON T, GOSSEZ M, et al. Monocyte HLA-DR expression in septic shock patients: insights from a 20-year real-world cohort of 1023 cases[J]. Intensive Care Med, 2025, 51(10):1820-1832. |
| [25] | YANG L, GAO Q, LI Q, et al. PD-L1 blockade improves survival in sepsis by reversing monocyte dysfunction and immune disorder[J]. Inflammation, 2024, 47(1):114-128. |
| [26] | ANDERSSON M, FR?DERBERG SCHOONER K, KARLSSON WERTHER V, et al. Prehospital lactate analysis in suspected sepsis improves detection of patients with increased mortality risk: an observational study[J]. Crit Care, 2025, 29(1):38. |
| [27] | WANG Y, GAO S, HONG L, et al. Prognostic impact of blood urea nitrogen to albumin ratio on patients with sepsis: a retrospective cohort study[J]. Sci Rep, 2023, 13(1): 10013. |
| [28] | GARCíA-CONCEJO A, SáNCHEZ-QUIRóS B, GóMEZ-SáNCHEZ E, et al. Study on the diagnostic role of exosome-derived miRNAs in postoperative septic shock and non-septic shock patients[J]. Crit Care, 2025, 29(1):96. |
| [29] | XU L, LI J, LI L, et al. LncRNA CYP1B1-AS1 as a clinical biomarker exacerbates sepsis inflammatory response via targeting miR- 18a- 5p[J]. BMC Immunol, 2025, 26(1):32. |
| [30] | SEYMOUR C W, LIU V X, IWASHYNA T J, et al. Assessment of clinical criteria for sepsis: for the third international consensus definitions for sepsis and septic shock (Sepsis-3)[J]. JAMA, 2016, 315(8):762-774. |
| [31] | PLE?KO D, BENNETT N, UKOR I F, et al. A framework and analytical exploration for a data-driven update of the Sequential Organ Failure Assessment (SOFA) score in sepsis[J]. Crit Care Resusc, 2025, 27(1):100105. |
| [32] | MORENO R, RHODES A, RANZANI O, et al. Rationale and methodological approach underlying the development of the Sequential Organ Failure Assessment (SOFA)-2 score: A consensus statement[J]. JAMA Netw Open, 2025, 8(10):e2545040. |
| [33] | RANZANI O T, SINGER M, SALLUH J I F, et al. Deve-lopment and validation of the Sequential Organ Failure Assessment (SOFA)-2 score[J/OL]. JAMA,2025-08-29. https://pubmed.ncbi.nlm.nih.gov/41159833/. |
| [34] | CHENOWETH J G, COLANTUONI C, STRIEGEL D A, et al. Gene expression signatures in blood from a West African sepsis cohort define host response phenotypes[J]. Nat Commun, 2024, 15(1):4606. |
| [35] | KALANTAR K L, NEYTON L, ABDELGHANY M, et al. Integrated host-microbe plasma metagenomics for sepsis diagnosis in a prospective cohort of critically ill adults[J]. Nat Microbiol, 2022, 7(11):1805-1816. |
| [36] | SCHLAPBACH L J, GANESAMOORTHY D, WILSON C, et al. Host gene expression signatures to identify infection type and organ dysfunction in children evaluated for sepsis: a multicentre cohort study[J]. Lancet Child Adolesc Health, 2024, 8(5):325-338. |
| [37] | BRANDES-LEIBOVITZ R, RIZA A, YANKOVITZ G, et al. Sepsis pathogenesis and outcome are shaped by the balance between the transcriptional states of systemic inflammation and antimicrobial response[J]. Cell Rep Med, 2024, 5(11):101829. |
| [38] | PALMOWSKI L, WEBER M, BAYER M, et al. Mortality-associated plasma proteome dynamics in a prospective multicentre sepsis cohort[J]. EBioMedicine, 2025, 111:105508. |
| [39] | BRACHT T, KAPPLER K, BAYER M, et al. Plasma proteomics identifies molecular subtypes in sepsis[J]. Crit Care, 2025, 29(1):392. |
| [40] | HUANG P, LIU Y, LI Y, et al. Metabolomics- and proteomics-based multi-omics integration reveals early metabolite alterations in sepsis-associated acute kidney injury[J]. BMC Med, 2025, 23(1):79. |
| [41] | MAYERS J R, VARON J, ZHOU R R, et al. A metabolomics pipeline highlights microbial metabolism in bloodstream infections[J]. Cell, 2024, 187(15):4095-4112.e21. |
| [42] | EVANS L, RHODES A, ALHAZZANI W, et al. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021[J]. Crit Care Med, 2021, 49(11):e1063-e1143. |
| [43] | GOH K H, WANG L, YEOW A Y K, et al. Artificial intelligence in sepsis early prediction and diagnosis using unstructured data in healthcare[J]. Nat Commun, 2021, 12(1):711. |
| [44] | SHASHIKUMAR S P, MOHAMMADI S, KRISHNAMOORTHY R, et al. Development and prospective implementation of a large language model based system for early sepsis prediction[J]. NPJ Digit Med, 2025, 8(1):290. |
| [45] | MALIC L, ZHANG P G Y, PLANT P J, et al. A machine learning and centrifugal microfluidics platform for bedside prediction of sepsis[J]. Nat Commun, 2025, 16(1):4442. |
| [46] | BHARGAVA A, LóPEZ-ESPINA C, SCHMALZ L, et al. FDA-authorized AI/ML tool for sepsis prediction: Deve-lopment and validation[J]. NEJM AI, 2024,1,AIoa2400867. |
| [47] | DIWAN S, GANDHI V, BAIDYA KAYAL E, et al. Explainable machine learning models for mortality prediction in patients with sepsis in tertiary care hospital ICU in low- to middle-income countries[J]. Intensive Care Med Exp, 2025, 13(1):56. |
| [48] | BRAKENRIDGE S C, CHEN U I, LOFTUS T, et al. Evaluation of a multivalent transcriptomic metric for diagnosing surgical sepsis and estimating mortality among critically ill patients[J]. JAMA Netw Open, 2022, 5(7):e2221520. |
| [49] | WANG S, LIU X, YUAN S, et al. Artificial intelligence based multispecialty mortality prediction models for septic shock in a multicenter retrospective study[J]. NPJ Digit Med, 2025, 8(1):228. |
| [50] | DE BACKER D, DEUTSCHMAN C S, HELLMAN J, et al. Surviving sepsis campaign research priorities 2023[J]. Crit Care Med, 2024, 52(2):268-296. |
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