Association between comorbid asthma and prognosis of critically ill patients with severe sepsis: a cohort study

Abstract

Basic research suggests some contributing mechanisms underlying asthma might at the same time benefit patients with asthma against sepsis, while the potential protective effect of comorbid asthma on prognosis of sepsis has not been well studied in clinical research. The study aimed to assess the association between comorbid asthma and prognosis in a cohort of patients admitted to intensive care unit (ICU) with severe sepsis. Patients with severe sepsis admitted to ICUs were included from the MIMIC-III Critical Care Database, and categorized as patients without asthma, patients with stable asthma, and patients with acute exacerbation asthma. The primary study outcome was 28-day mortality since ICU admission. Difference in survival distributions among groups were evaluated by Kaplan–Meier estimator. Multivariable Cox regression was employed to examine the association between comorbid asthma and prognosis. A total of 2469 patients with severe sepsis were included, of which 2327 (94.25%) were without asthma, 125 (5.06%) with stable asthma, and 17 (0.69%) with acute exacerbation asthma. Compared with patients without asthma, patients with asthma (either stable or not) had a slightly younger age (66.73 ± 16.32 versus 64.77 ± 14.81 years), a lower proportion of male sex (56.81% versus 40.14%), and a lower median SAPS II score (46 versus 43). Patients with acute exacerbation asthma saw the highest 28-day mortality rate (35.29%), but patients with stable asthma had the lowest 28-day mortality rate (21.60%) when compared to that (34.42%) in patients without asthma. Consistent results were observed in Kaplan–Meier curves with a p-value for log-rank test of 0.016. After adjusting for potential confounding, compared to being without asthma, being with stable asthma was associated with a reduced risk of 28-day mortality (hazard ratio (HR) 0.65, 95% confidence interval (CI) 0.44–0.97, p = 0.0335), but being with acute exacerbation asthma was toward an increased risk of 28-day mortality (HR 1.82, 95% 0.80–4.10, p = 0.1513). E-value analysis suggested robustness to unmeasured confounding. These findings suggest comorbid stable asthma is associated with a better prognosis in critically ill patients with severe sepsis, while acute exacerbation asthma is associated with worse prognosis.

A comparison of impact of comorbidities and demographics on 60-day mortality in ICU patients with COVID-19, sepsis and acute respiratory distress syndrome

“…While almost all comorbidities under investigation were of similar importance with regard to 60-day mortality in COVID-19 and Sepsis as well as in COVID-19 and ARDS, we found a differential effect for asthma. Asthma showed a stronger association to 60-day mortality in COVID-19 than in Sepsis possibly relating to previous evidence that asthma is associated to a better prognosis in Sepsis 28 . This finding is also consistent with a previous study in which an independent association was found between asthma and COVID-19 ICU-mortality 15 .…”

Correlation between Balthazar CT grading, CECT necrosis volume, attenuation value, and prognosis of patients with acute necrotizing pancreatitis

“…[15][16][17][18] Balthazar CT grading is a grading method to evaluate the lesions of pancreatic parenchyma and surrounding tissues according to pancreatic morphology, inflammation and other conditions. [19,20] Studies have shown that the larger the volume of necrosis in the pancreas and peripancreatic area, the higher the density of necrosis, the slower the absorption and dissipation, the more serious the erosion effect on peripancreatic tissue, and the larger the CT attenuation value. [21,22] Multivariate logistics analysis of this study showed that Balthazar CT grade, necrotic volume and mean attenuation value were independent risk factors for poor prognosis in patients with acute necrotizing pancreatitis.…”

Unveiling the Causal Association Between Noninfectious Respiratory Disorders and Sepsis Through Mendelian Randomization Analysis

“…40 Activated immune cells may have protective effects against infections. 5,41 Furthermore, scholarly evidence suggests that unique immunoregulatory pathways may be involved in mitigating the systemic spread of inflammatory reactions in individuals with asthma, potentially reducing the severity of sepsis. 42,43 The prevalence of Th2-type immune responses may also aid in dampening the hyperinflammatory reactions associated with sepsis.…”