From cardiac injury to omics signatures: a narrative review on biomarkers in septic cardiomyopathy

Background Septic cardiomyopathy (SCM) is a frequent and underdiagnosed complication of sepsis that contributes significantly to patient morbidity and mortality. Its pathophysiology involves myocardial inflammation, mitochondrial dysfunction, and microcirculatory abnormalities. Despite growing recognition, the diagnostic approach to SCM remains inconsistent, and validated biomarkers are lacking. Methods This narrative review explores the current landscape of SCM biomarkers. PubMed, Scopus, and EMBASE were searched from inception to June 2025. Results Traditional biomarkers are useful, but nonspecific in the septic context. Emerging biomarkers offer promising diagnostic and prognostic information, particularly in combination. Multi-omics strategies revealed transcriptomic and proteomic profiles to be potentially specific for SCM and may facilitate early detection and risk stratification. However, limitations remain in terms of standardization, assay reproducibility, and clinical translation. Composite biomarker panels and longitudinal monitoring appear to be more informative than single-point measurements. Conclusions SCM remains a diagnostic challenge, although biomarker research is rapidly evolving. Integrating traditional and emerging biomarkers, supported by multi-omics and computational tools, may enable a shift toward precision medicine in sepsis-related cardiac dysfunction. Future efforts should focus on consensus definitions, validation in prospective cohorts, and biomarker-guided interventions to improve patient outcomes.