LAUSR

The April 2019 issue of Shock provides a fresh mixture of clinical observational and preclinical translational studies centered on important aspects of sepsis, inflammation, organ injury, and critical illness. The main theme of the clinical studies in this issue of Shock is the quest for biomarkers to predict outcomes in critical illness. In a single-center prospective observational study, Kastl et al. (1) evaluated whether systemic levels of intestinal fatty acid-binding protein (iFABP, also known as fatty acid-binding protein 2 (FABP2)) could serve as outcomes biomarker in patients with acute heart failure or cardiogenic shock. The authors observed in 90 consecutive patients that high iFABP levels on the day of intensive care unit admission were associated with low 30-day survival, thus suggesting potential predictive value of iFABP in these patient populations. Because iFABP expression is limited to the intestine and released into the systemic circulation from injured or hypoxic enterocytes, the authors conclude that early intestinal hypoperfusion might be associated with mortality in patients with acute heart failure or cardiogenic shock (1). In another prospective observational study Barnaby et al. (2) enrolled 1,247 patients to derive and evaluate a predictive model containing clinical, laboratory, and heart rate variability measures to quantify risk of deterioration in patients with sepsis admitted to the emergency department. The authors show that the combination of laboratory values and heart rate variability metrics improves prediction of clinical deterioration, suggesting that such a model could facilitate risk stratification for sepsis patients in the emergency department. In two retrospective observational studies, changes in leukocyte counts and morphology were associated with outcomes (3,4). Chung et al. (3) performed a retrospective analysis of prospectively collected data to evaluate the associations of circulating monocyte counts with mortality, bacteremia and organ dysfunction in sepsis and septic shock patients. Furthermore, the authors were able to compare monocyte counts at the manifestation of sepsis with monocyte counts that were obtained 3 months to 2 weeks prior to the manifestation of sepsis. Chung et al. report that monocyte counts were independently associated with mortality in multivariate logistic regression analyses and that sepsis patients with low initial monocyte