Fraioli V, Sanvitti M, Bilotta F. MicroRNAs in sepsis: Advances in diagnosis and prognostic monitoring. World J Crit Care Med 2026; 15(1): 114225 [DOI: 10.5492/wjccm.v15.i1.114225]
Corresponding Author of This Article
Federico Bilotta, MD, PhD, Professor, Department of Anesthesiology and Intensive Care, University of Tor Vergata, Via Cracovia 50, Rome 00133, Lazio, Italy. bilotta@tiscali.it
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Biochemistry & Molecular Biology
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Minireviews
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Mar 9, 2026 (publication date) through Mar 3, 2026
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World Journal of Critical Care Medicine
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2220-3141
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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
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Fraioli V, Sanvitti M, Bilotta F. MicroRNAs in sepsis: Advances in diagnosis and prognostic monitoring. World J Crit Care Med 2026; 15(1): 114225 [DOI: 10.5492/wjccm.v15.i1.114225]
World J Crit Care Med. Mar 9, 2026; 15(1): 114225 Published online Mar 9, 2026. doi: 10.5492/wjccm.v15.i1.114225
MicroRNAs in sepsis: Advances in diagnosis and prognostic monitoring
Valeria Fraioli, Marco Sanvitti, Federico Bilotta
Valeria Fraioli, Federico Bilotta, Department of Anesthesiology and Intensive Care, University of Tor Vergata, Rome 00133, Lazio, Italy
Marco Sanvitti, Department of Pediatric Surgery, Sapienza University of Rome, Rome 00185, Lazio, Italy
Author contributions: Fraioli V was responsible for conceptualizing and designing the review, performing the literature search, analyzing and interpreting the data, and drafting the original manuscript; Sanvitti M assisted with data extraction, literature review, and manuscript preparation; Bilotta F was responsible for supervising the project, providing critical revisions, and overseeing the overall direction of the work; all authors contributed to manuscript drafting and approved the final version.
Conflict-of-interest statement: All authors declare no conflict of interest in publishing the manuscript.
Corresponding author: Federico Bilotta, MD, PhD, Professor, Department of Anesthesiology and Intensive Care, University of Tor Vergata, Via Cracovia 50, Rome 00133, Lazio, Italy. bilotta@tiscali.it
Received: September 15, 2025 Revised: October 7, 2025 Accepted: December 16, 2025 Published online: March 9, 2026 Processing time: 167 Days and 12.4 Hours
Abstract
Sepsis and septic shock remain major global health challenges, with persistently high mortality despite advances in critical care. Conventional diagnostic tools, including the Sequential Organ Failure Assessment score and biomarkers such as C-reactive protein and procalcitonin, lack sufficient sensitivity and specificity, particularly in early disease. Circulating microRNAs (miRNAs), small non-coding RNAs regulating gene expression, have emerged as promising biomarkers for early diagnosis, prognostic assessment, and therapeutic monitoring. This narrative review synthesizes clinical studies published after 2022, highlighting the evolving role of circulating and extracellular vesicle-derived miRNAs in sepsis. Diagnostic investigations confirmed the accuracy of miRNA-451a (miR-451a) and miR-9-5p, while expanding evidence supports miR-193b-5p and miR-135a as additional diagnostic candidates. Contrasting results on miR-181a-5p emphasize the need for further validation. Prognostic and therapeutic monitoring studies identified miR-155, miR-182, miR-146b-5p, miR-126-5p, miR-195, and miR-497 as dynamic markers reflecting immune modulation and disease trajectory. Collectively, these findings highlight circulating miRNAs as powerful, versatile biomarkers that advance precision medicine in sepsis, pending multicenter validation and methodological standardization for clinical translation.
Core Tip: Circulating microRNAs (miRNAs) are emerging as stable and specific biomarkers for sepsis and septic shock diagnosis, prognosis, and therapeutic monitoring. Recent studies validate miRNA-451a (miR-451a), miR-9-5p, miR-193b-5p, miR-135a, miR-155, and miR-182 as superior to conventional markers, reflecting disease severity and immune status. Future diagnostic strategies may benefit from combination miRNA panels, which could enhance accuracy and support precision medicine in sepsis care. Large multicenter studies and methodological standardization remain essential to ensure reproducibility and enable their integration into clinical practice.
