MicroRNAs in sepsis: Advances in diagnosis and prognostic monitoring

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.