RT preprint
T1 Interference of Type 2 Diabetes Mellitus in the Early Diagnosis of Sepsis: Clinical Challenges and Biomarkers
A1 Contreras-Virues, Mario Raul
A1 Vera Jiménez, José Carlos
A1 Brea-Salvago, Juan Francisco
A1 Moreno Corbacho, Ignacio
A1 García Ortiz, José Carlos
A1 Díaz Gómez, Alfredo Luis
A1 Ribelles García, Antonio
A1 Pérez Arana, Gonzalo Martín
A2 Anatomía PatológicaBiología Celular, Histología, Historia de la Ciencia, Medicina Legal y Forense y Toxicología
A2 Anatomía y Embriología Humana
K1 Sepsis
K1 T2DM
K1 Biomarkers
K1 Inmune dysfunction
K1 early diagnosis
AB Background/Objectives: Type 2 diabetes mellitus (T2DM) substantially increases the risk of infection and sepsis while modifying host immune responses, clinical presenta-tion, and biomarker performance. This review summarizes the pathophysiological mechanisms by which T2DM interferes with the early recognition of sepsis and criti-cally evaluates the performance of conventional and emerging biomarkers in this spe-cific population. Methods: A narrative review of the literature was conducted using PubMed, Scopus, and Web of Science. Original studies, systematic reviews, me-ta-analyses, international guidelines, and landmark publications addressing the inter-action between T2DM, sepsis, immune dysfunction, and sepsis biomarkers were criti-cally analyzed. Results: Chronic hyperglycemia induces immune dysregulation, endo-thelial dysfunction, and persistent low-grade inflammation, resulting in atypical infec-tion presentations and reduced sensitivity of conventional clinical assessment tools. Baseline elevations and altered kinetics of C-reactive protein, procalcitonin, interleu-kin-6, and other inflammatory biomarkers may reduce their diagnostic specificity. Lactate retains prognostic value but should be interpreted cautiously in patients with diabetic ketoacidosis or other metabolic disturbances. Emerging biomarkers, including presepsin, pro-adrenomedullin, soluble urokinase plasminogen activator receptor, cell-free DNA, and 16S rRNA, show promising diagnostic potential, although evidence in diabetic populations remains limited. Conclusions: T2DM represents a distinct clin-ical phenotype in sepsis that requires individualized interpretation of biomarkers. Multimarker strategies integrating clinical, metabolic, and laboratory data may im-prove early sepsis recognition, but prospective validation studies in diabetic popula-tions are still needed.
PB MDPI
SN 2077-0383
YR 2026
FD 2026
LK http://hdl.handle.net/10498/40106
UL http://hdl.handle.net/10498/40106
LA eng
DS Repositorio Institucional de la Universidad de Cádiz
RD 05-nov-2026