New Insights in Microcirculation Research in Sepsis

Sepsis remains a leading cause of morbidity and mortality worldwide, with certain high-risk populations—including elderly patients, neonates, immunocompromised individuals, those with chronic diseases, and pregnant women—experiencing worse outcomes. These groups exhibit distinct pathophysiological responses, which complicate diagnosis, treatment, and prognosis. Despite advancements in sepsis management, challenges persist in early risk stratification, individualized therapeutic strategies, and long-term recovery. Aim: This study aims to evaluate the impact of sepsis on high-risk populations, identify prognostic factors influencing clinical outcomes, and explore personalized treatment approaches to optimize patient management. Methodology: A systematic narrative review was conducted, following PRISMA guidelines, by analyzing peer-reviewed literature from 2015 to 2025. This study included the analysis of 80 scientific articles from eight international databases. Studies focusing on sepsis pathophysiology, microcirculatory dysfunction, diagnostic techniques, therapeutic interventions, and post-sepsis outcomes in high-risk populations were included. Results: Elderly patients demonstrated the highest sepsis-related mortality rates (>40%), while neonates and immunocompromised individuals exhibited delayed inflammatory responses, complicating diagnosis. Prognostic biomarkers such as IL-6 and IL-10 showed potential utility in these populations. Personalized fluid resuscitation, antimicrobial stewardship, and immune-modulating therapies were identified as critical to improving outcomes. Post-sepsis syndrome (PSS) was prevalent, particularly in survivors with chronic comorbidities and prolonged ICU stays. Conclusions: Optimizing sepsis management in high-risk populations requires a multidisciplinary, personalized approach, incorporating early biomarker-based diagnostics, precision-guided hemodynamic support, and tailored rehabilitation programs. Future research should focus on novel immunotherapies, antimicrobial resistance strategies, and long-term functional recovery in sepsis survivors.