Sapru et al. show in this issue of Critical Care that variants of thrombomodulin and the endothelial protein C receptor, but not protein C, are associated with mortality and organ dysfunction (ventilation-free and organ failure-free days) in ARDS. There remain huge challenges but great opportunities for genomics, and I think more importantly for PGx of sepsis. We are close—but yet so far because there are many complex steps and milestones to bring a novel PGx biomarker to septic patients and their caregivers.

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