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BACKGROUND: A reliable biomarker as an indicator of the presence of severe sepsis is an unmet medical need. METHODS: Review of recent literature on this topic focusing upon endotoxin and cytokine assays. RESULTS: The ideal biomarker for sepsis would be readily available, technically easy to perform with a quick turn-around time, inexpensive, highly specific, very sensitive, and preferably highly correlated in quantitative terms with disease severity. Such a test would provide early diagnostic accuracy, prognostic information, and indicate responsiveness to treatment interventions. Regrettably no such biomarker exists for sepsis at present, and it is not likely that such an ideal assay will be developed in the foreseeable future. CONCLUSIONS: Despite their shortcomings, a number of existing and candidate biomarker assays are available and can provide some useful information to the clinician caring for septic patients. The relative merits of endotoxin measurement, interleukin-6 levels and a variety of other sepsis markers are reviewed. Full implementation of these biomarkers may improve diagnostic accuracy over the standard clinical criteria for sepsis. PMID: 17464131