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Genomic Applications in Critical Care Medicine 

Genomic Applications in Critical Care Medicine
Chapter:
Genomic Applications in Critical Care Medicine
Author(s):

Matthew C. Frise

, Charles Hinds

, and Julian C. Knight

DOI:
10.1093/med/9780199896028.003.0048
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date: 29 May 2020

A general ICU will admit patients with a broad range of conditions but the most important single cause of death, irrespective of admission diagnosis, remains sepsis. The underlying infection may have been the primary reason for hospital admission or may have been acquired in the hospital or ICU. Most patients who acquire an infection in the community or hospital, such as community acquired pneumonia (CAP), will not become critically ill. In some cases recognisable factors such as significant comorbidity or a particularly virulent pathogen lead to greater illness severity. Often, however, those individuals who fare worse are outwardly no different from the vast majority of those infected, leading clinicians to suspect that genetic factors must play an important role. Genetic influence on infectious disease in general is non-controversial. Particular questions relevant to the critically ill include firstly, whether identifiable genetic factors lead to an increased likelihood of requiring ICU admission, which might permit early identification and treatment of high-risk individuals. Secondly, once admitted to ICU, do genetic factors predict a greater likelihood of developing a particular complication such as acute respiratory distress syndrome (ARDS) or septic shock, such that therapy could be tailored to be of maximum benefit? Thirdly does genomic medicine help us assess how patients might respond or are responding to a given treatment, so that interventions can be individualised and modified appropriately? If the answer to any of these questions is yes, then there is the potential to significantly reduce morbidity, mortality and costs. Thus genomics in future is likely to play an important part in managing critically ill patients.

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