1st Revision: Ha Nguyen 
The original title of the article “Association between comorbid asthma and prognosis of critically ill patients with severe sepsis: a cohort study”
Originally written by Huang et al. 2021
https://www.nature.com/articles/s41598-021-93907-0
By: Murielle Nsiela
Asthma is one of the most common lung diseases that does not discriminate with age; it affects individuals of all ages ranging from young kids to adults. Despite the health challenges associated with Asthma, it generally has a good prognosis if the symptoms are well managed to reduce the risks of exacerbation. In addition, sepsis itself is a clinical syndrome with physiological, biological, and biochemical abnormalities. It is caused by a negative host response to infection leading to organ dysfunction, which is life-threatening7. However, it is still difficult to manage sepsis as the mortality rate ranges from 10 to 50%4.
Research has suggested that certain asthma mechanisms might help protect asthma patients against sepsis8. In the disease pathway of asthma, several cellular processes occur, which triggers the disease. Research has shown that some of these cellular processes play an essential role in decreasing the spread of infection1. These cellular factors have been found in large amounts in patients that survived the infection compared to those who died5.
Furthermore, there have also been reports of a reverse association between asthma and sepsis. It has been suggested that specific physiological processes that lead to the risk of severe sepsis are linked with a reduced risk of asthma2. Despite these findings, there is limited evidence from clinical research investigating the effects of asthma on the prognosis of extremely ill patients with severe sepsis. Hence, the paper by Huang et al., 20213 has demonstrated this.
The study involved patients without asthma, with stable asthma, and patients with acute exacerbation asthma. Although the statistical difference was not as much between the three groups, they found that patients with acute exacerbation asthma had the highest mortality rate at 35.29%. However, patients with stable asthma had the lowest mortality rate with 21.60%, compared to those without asthma, with a 34.42% mortality rate.
Overall, the study demonstrated that stable asthma is linked with a better prognosis in patients with severe sepsis in the intensive care unit. At the same time, acute exacerbation asthma produces the opposite results in patients with severe sepsis. The paper also highlights that they were able to distinguish the different roles between stable asthma and acute exacerbation asthma. This increased knowledge in the field and further showed that comorbid asthma could potentially have a beneficial effect on the prognosis of sepsis. However, the protective effects may only exist in stable asthma3.
In conclusion, the mechanism causing asthma could have protective effects in patients with severe infections. Furthermore, this study paves the way for future researchers to potentially avoid sepsis infection outcomes in patients without asthma when the mechanism is better understood.
References:
- Freitas, A., Alves-Filho, J., Victoni, T., Secher, T., Lemos, H., Sônego, F., Cunha, F. and Ryffel, B., 2009. IL-17 Receptor Signaling Is Required to Control Polymicrobial Sepsis. The Journal of Immunology, 182(12), pp.7846-7854.
- Gao, L., Grant, A., Rafaels, N., Stockton-Porter, M., Watkins, T., Gao, P., Chi, P., Muñoz, M., Watson, H., Dunston, G., Togias, A., Hansel, N., Sevransky, J., Maloney, J., Moss, M., Shanholtz, C., Brower, R., Garcia, J., Grigoryev, D., Cheadle, C., Beaty, T., Mathias, R. and Barnes, K., 2007. Polymorphisms in the myosin light chain kinase gene that confer risk of severe sepsis are associated with a lower risk of asthma. Journal of Allergy and Clinical Immunology, 119(5), pp.1111-1118.
- Huang, J., Zhang, J., Wang, F., Liang, J., Chen, Q. and Lin, Z., 2021. Association between comorbid asthma and prognosis of critically ill patients with severe sepsis: a cohort study. Scientific Reports, 11(1).
- Kaukonen, K., Bailey, M., Pilcher, D., Cooper, D. and Bellomo, R., 2015. Systemic Inflammatory Response Syndrome Criteria in Defining Severe Sepsis. New England Journal of Medicine, 372(17), pp.1629-1638.
- Krishack, P., Louviere, T., Decker, T., Kuzel, T., Greenberg, J., Camacho, D., Hrusch, C., Sperling, A. and Verhoef, P., 2019. Protection against Staphylococcus aureus bacteremia-induced mortality depends on ILC2s and eosinophils. JCI Insight,
- Miller, R., Dong, L., Nelson, N., Brown, S., Kuttler, K., Probst, D., Allen, T. and Clemmer, T., 2013. Multicenter Implementation of a Severe Sepsis and Septic Shock Treatment Bundle. American Journal of Respiratory and Critical Care Medicine, 188(1), pp.77-82.
- Singer, M. et al., 2016 The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). The Journal of the American Medical Association, 315(8), pp.801–810.
- Sutherland, R., Xu, X., Kim, S., Seeley, E., Caughey, G. and Wolters, P., 2011. Parasitic Infection Improves Survival from Septic Peritonitis by Enhancing Mast Cell Responses to Bacteria in Mice. PLoS ONE, 6(11), p.e27564.
