It's all in the genes: Moving toward precision medicine in critical illness

摘要

Although early identification of critically ill patients at increased risk for the development of organ failures and death continues to be an important goal, selecting patients at high likelihood for response to tailored interventions is an even more tantalizing objective. Physiologically based scoring systems, such as Acute Physiology and Chronic Health Evaluation and Simplified Acute Physiologic Score, have been shown to possess value in predicting outcome but not in choosing specific therapies (1, 2). Similarly, although the levels of a number of biomarkers, including interleukin-6, interleukin-8, and von Willebrand factor, both in the circulation and in localized anatomic sites, such as in the bronchoal-veolar lavage, correlate with the development and persistence of organ dysfunction, as well as with likelihood for survival, there is no evidence that they provide clinically useful information in guiding the selection of pharmacologic or other interventions in critically ill patients (3-6).