From early recognition to precision medicine: advances in the diagnosis and management of adult sepsis and septic shock-a narrative review.

Abstract

Purpose: Emerging diagnostic, computational, and precision approaches are expanding the ability to detect, classify, and biologically characterise sepsis, but their translation into clinical benefit depends on whether added information changes management and, ultimately, improves patient-centred outcomes. This review evaluates selected advances in adult sepsis and septic shock through a framework of clinical actionability.

Methods: A focused PubMed search was supplemented by major international guidelines, targeted searches, and reference-list screening through August 2026. Priority was given to randomised trials, systematic reviews and meta-analyses, multicentre studies, and prospective or external validation studies relevant to clinical implementation.

Results: We developed a two-gap framework to distinguish gains in information from clinically meaningful translation. The information-to-action gap describes situations in which improved detection, prediction, biological classification, or physiological assessment does not alter management; the decision-to-outcome gap describes management changes without demonstrated patient-centred benefit. Digital alerts, rapid diagnostics, host-response assays, physiology-guided resuscitation, and phenotype- or biomarker-guided strategies show differing degrees of actionability. Across these domains, reproducibility, transportability, workflow integration, timing, temporal stability, and treatment-predictive validity remain key constraints.

Conclusion: Most of the emerging diagnostic, computational, and precision approaches reviewed here have not yet established a routine role in sepsis care. Established evidence-based management therefore remains the clinical foundation, while newer strategies should be evaluated prospectively for their ability to close the information-to-action and decision-to-outcome gaps.