Interestingly, this attenuated increase in a susceptible cohort in a chronic disease is reminiscent of serum Esm-1 levels in patients with acute lung injury, i.e., inflammatory mediators that accompany sepsis can induce Esm-1, but the patients with higher mortality, presumably due to more inflammation, had a smaller increase in Esm-1[43]. Here, ESM1 is linked to injury.