New Hopes for Sepsis Patients, Neonatal Treatment Pivots, and the Toll of Bronchiectasis

From Featured Buzz, December 1, 2025

New Hope for Patients with Sepsis-Induced Lung Injury
Patients who suffer from Acute Lung Injury (ALI) caused by sepsis often experience severe thrombosis as well. Still, clinical trials evaluating anticoagulant therapies in these patients have not achieved the intended outcomes.

Researchers from Ann & Robert H. Lurie Children’s Hospital of Chicago have discovered a possible new mechanism of disease development in patients with sepsis-caused ALI or acute respiratory distress syndrome that may one day lead to an effective treatment.

The investigation began with the discovery that while severe lung thrombosis is highly detrimental during sepsis, mild lung thrombosis actually has a beneficial effect. From there, the researchers found that these beneficial effects are mediated by a gene called ALOX15, which acts within the endothelium to produce lipids.

One of those lipids protects lung blood vessels from sepsis-induced damage.

“We provide unequivocal evidence that mild lung thrombosis unexpectedly inhibits sepsis-induced lung injury. This is a paradigm shift, since we know clinically and from our experiments that either too much blood clotting or not enough increases lung damage from sepsis,” said study author YouYang Zhao, PhD. “The key turned out to be the extent of ALOX15 gene expression.”

Dr. Zhao believes novel therapies that enhance ALOX15 gene expression or provide ALOX15-dependent protective lipids might offer hope for patients with sepsis-induced lung injury. He and his team plan to test the safety and effectiveness of these therapies in mice, and if those experiments are successful, begin clinical trials within a few years.

Circulation Research published the study.

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Adding Steroid to Surfactant Therapy Does Not Benefit Extremely Preterm Infants
A recent study led by investigators from the National Institute of Child Health and Human Development’s Neonatal Research Network has found that adding a dose of the steroid budesonide to surfactant therapy administered intratracheally to extremely preterm infants does not protect those infants from developing bronchopulmonary dysplasia (BPD).

The clinical trial, published in JAMA, involved 641 infants born between 22 and 28 weeks of gestation or weighing between 401 and 1,000 grams. All received surfactant therapy within 50 hours of birth. Half of the infants were randomized to receive an additional dose of budesonide, and the other half received surfactant alone.

After an interim analysis showed no significant benefit for the added dose of budesonide — the incidence of BPD or death by 36 weeks of age was 68.5% in the budesonide-surfactant group vs. 67.9% in the surfactant-only group — the trial was stopped early. Hyperglycemia was more common in the budesonide-surfactant group (66.7%) than in the surfactant-only group (49.8%).

The clinical trial was initially spurred by several smaller studies suggesting a benefit of adding budesonide to surfactant therapy for extremely preterm infants. Still, the authors believe their larger, more rigorous multicenter trial shows it has little merit.

However, they haven’t completely given up on the therapy. They now plan to look at its effects in specific infants, such as those who experience inflammation or have certain genetic predispositions.

The goal will be to find a more tailored approach.

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Bronchiectasis Costs are Higher, Outcomes are Worse
According to a paper based on data from the U.S. National Inpatient Sample, which reflects about 20% of hospital discharges across the country, hospitalizations for bronchiectasis are significantly more expensive than those for COPD or asthma, and patients have worse outcomes.

The study analyzed patient demographics, length of stay (LOS), mortality, comorbidities, and hospital characteristics, along with the impact of the COVID-19 pandemic on mortality and hospitalization rates, for patients treated between 2017 and 2021.

Patients with overlapping conditions, such as COPD, bronchiectasis, and asthma, were also examined.

Results showed:

• 232,825 patients had bronchiectasis, 8,403,302 had COPD, and 1,278,839 had asthma.
• Women comprised 71% of the asthma cohort, 59% of the bronchiectasis cohort, and 53.3% of the COPD cohort.
• 79.4% of patients in the COPD cohort, 73.2% in the bronchiectasis cohort, and 51.9% in the asthma cohort were white.
• The median LOS was highest in the bronchiectasis cohort, at five days, and lowest in the asthma cohort, at three days.
• Bronchiectasis costs were also the highest, at $50,393 per hospitalization.
• Crude mortality was 5.8% for bronchiectasis patients, 5.0% for those with COPD, and 1.5% for those with asthma.
• After adjusting for comorbidities, patients hospitalized with bronchiectasis exacerbations were 1.2 times more likely to die than those with COPD exacerbations and 3.0 times more likely to die than those with asthma exacerbations.
• A 26% and 28% decline in hospitalization rates for COPD and asthma exacerbations, respectively, was observed during the COVID-19 pandemic, whereas the rate decreased by only 8% for bronchiectasis exacerbations.
• COPD and asthma hospitalizations continued to decline in 2021, while bronchiectasis hospitalizations increased, rising from 42,374 in 2020 to 45,866 in 2021, bringing the total to near pre-pandemic levels.
• Mortality rates remained relatively stable during the pre-pandemic years across all three cohorts. Still, they rose significantly in 2020 and again in 2021, with the greatest increase seen in the bronchiectasis cohort, where mortality climbed from about 4.3% pre-pandemic to 7.3% in 2020 and 9.3% in 2021.
• Hospitalizations for bronchiectasis alone were associated with higher mortality rates than bronchiectasis-COPD or bronchiectasis-asthma overlap; compared to bronchiectasis-asthma overlap patients, patients with bronchiectasis-only exacerbations were over three times more likely to die.

The authors of the study believe these findings suggest a need for “more targeted management strategies and increased awareness of bronchiectasis to improve patient outcomes and further reduce health care burden.”

The study was published in the European Respiratory Journal.

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