In 1900, Dr. Camac wrote in the Journal of the American
Medical Association “Rarely in our science is that any one finding is the open
sesame to the secrets of the disease” [1].
In 2020, these words remain relevant, as a reminder that the complexities of
both pathophysiology and patient care have always rendered any one test only a
part of the puzzle. Regarding biomarkers, definitions vary, with most broad and
encompassing many test types [2].
We focus on laboratory-based biomarkers, and contend that before widespread
adoption of a given biomarker, we should ask four questions—what is the pretest
probability for the diagnosis we are considering, are factors present that
interfere with interpretation of the result, will I change management based on
the result, and what will the outcome benefit be (Table 1)?
We further contend that for many biomarkers, robust answers to these questions
are lacking and support this position with illustrative examples of novel and
commonly used biomarkers in the ICU.
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