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Crit Care. 2017 Oct 18;21(1):257. doi: 10.1186/s13054-017-1836-5.

Precision medicine for all? Challenges and opportunities for a precision medicine approach to critical illness.

Author information

1
The Clinical Research, Investigation, and Systems Modeling of Acute illness (CRISMA) Center, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA. seymourcw@upmc.edu.
2
Department of Critical Care Medicine, University of Pittsburgh School of Medicine, 3550 Terrace Street, 639 Scaife Hall, Pittsburgh, PA, 15261, USA. seymourcw@upmc.edu.
3
The Clinical Research, Investigation, and Systems Modeling of Acute illness (CRISMA) Center, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
4
Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
5
Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA.
6
Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA.

Abstract

All of medicine aspires to be precise, where a greater understanding of individual data will lead to personalized treatment and improved outcomes. Prompted by specific examples in oncology, the field of critical care may be tempted to envision that complex, acute syndromes could bend to a similar reductionist philosophy-where single mutations could identify and target our critically ill patients for treatment. However, precision medicine faces many challenges in critical care. These include confusion about terminology, uncertainty about how to divide patients into discrete groups, the challenges of multi-morbidity, scale, and the need for timely interventions. This review addresses these challenges and provides a translational roadmap spanning preclinical work to identify putative treatment targets, novel designs for clinical trials, and the integration of the electronic health record to implement precision critical care for all.

KEYWORDS:

Critical illness; Phenotypes; Precision medicine

PMID:
29047353
PMCID:
PMC5648512
DOI:
10.1186/s13054-017-1836-5
[Indexed for MEDLINE]
Free PMC Article

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