Personalised medicine shows early success in preventing kidney injury after major surgery
核心洞察
Researchers at the University of Münster (搜索) report initial success using biomarkers to identify patients at high risk of kidney damage after major surgery and applying preventive treatment immediately post-operatively.
Sepsis (搜索) accounts for nearly a third of all deaths worldwide, according to the Global Burden of Disease Study, underscoring the urgency of personalised approaches to systemic inflammation (搜索).
The findings stem from the BigpAK-2 multinational randomised clinical trial, published in The Lancet, which evaluated a preventive care strategy to reduce moderate or severe acute kidney injury (搜索).
Scientists at the University of Münster (搜索) are reporting initial successes with personalised medicine to combat life-threatening systemic inflammations, marking a step toward tailoring treatment to each patient's individual risk profile. "Our research has found for instance that the danger of kidney damage from inflammatory responses following major surgery can be reduced if we use new biomarkers to determine a patient's individual risk," said critical care doctor Professor Alexander Zarbock, speaking ahead of World Sepsis (搜索) Day on 13 September.
The approach identifies patients at especially high risk of kidney damage and applies preventive treatment immediately after their operation. "This includes precisely controlling their circulation and fluid balance, closely monitoring kidney values and ensuring the patient is given no medication that could have a detrimental effect on the kidneys," Zarbock explained. The researchers' goal is to have these findings incorporated into international guidelines for the treatment of sepsis (搜索) and other types of systemic inflammation (搜索).
The case for personalised treatment
Critical care specialist Professor Jan Rossaint emphasised that every patient with a systemic inflammation (搜索) such as sepsis (搜索) presents with their own particular circumstances. "However, only in the last decade has research shown more clearly that this can have a crucial bearing on the way the inflammation develops," he said. While the disease and its symptoms ultimately follow a similar pattern, the triggers and affected organs differ, and a patient's genetic factors, pre-existing conditions, and concurrent medications all exert an influence. "We need personalised treatments," Rossaint stressed.
The clinical burden is substantial. According to the Global Burden of Disease Study, sepsis (搜索) is responsible for nearly a third of all deaths worldwide. Triggered by infection, sepsis is an inflammatory immune system response that spreads throughout the body. Rossaint and Zarbock head the University of Münster (搜索)'s Clinical Research Unit "Organ Dysfunction during Systemic Inflammation (搜索)" (CRU 342), whose scientists study why inflammatory processes lead to the failure of vital organs.
Beyond infection: inflammation without pathogens
Sepsis (搜索) is induced by molecular components of bacteria or viruses that trigger the immune response, but inflammations that do not involve any infection are equally dangerous. "We see this for example in patients who have severe tissue trauma after road traffic accidents, or following major surgery such as organ transplants, when the blood starts flowing back into the vessels, resulting in inflammatory stimuli," Rossaint explained. In these cases, the immune system reacts to proteins released by injured cells, and if a certain immune activation threshold is exceeded, the inflammation can cause potentially fatal organ damage.
Ongoing research in cardiac surgery
Rossaint and his colleagues are currently investigating which patients face an elevated risk of developing systemic inflammation (搜索) following heart surgery in particular. The team is examining values routinely checked at the hospital—such as changes in blood counts, typical inflammatory markers, and clinical parameters like blood pressure, heart rate, and organ function. In addition, the scientists use flow cytometry to analyse hundreds of parameters relating to different types of white blood cells before, during, and after surgery, including cell membrane receptors and cellular messengers. "We search through this data, looking for combinations that can predict how high a patient's individual risk of suffering complications as a result of inflammatory responses is," Rossaint said.
From bench to bedside
Rossaint cautioned that it remains too early to translate this research into routine clinical applications. "Medical research takes a great deal of time and a great deal of freedom because it's not a linear process. We have to keep asking new questions and searching for explanations when something doesn't work," he said. He also underscored the role of animal experiments in achieving medical progress, noting that "tissue models are unable to adequately replicate the processes taking place within the highly complex system that is the human body."
The underlying clinical evidence is published in The Lancet as the BigpAK-2 trial, a multinational, randomised clinical trial evaluating a preventive care strategy to reduce moderate or severe acute kidney injury (搜索) after major surgery (Zarbock A, Ostermann M, Forni L et al., The Lancet, 2025; 406, 2782-2791). Rossaint attributed the translational potential of this work to the close ties between universities and university hospitals. "If we discover new correlations in tests with mice, it's easy to get access to samples from the hospital to quickly check what role they play in the human body and adapt our projects accordingly," he said, adding that the statistical and scientific analysis of patient groups "simply wouldn't be possible without the cooperation between the hospital and the university."