TY  - JOUR
AB  - BACKGROUND: Despite therapeutic advancements, asthma exacerbations (AEs) remain a major clinical challenge, with immune-inflammatory patterns incompletely characterized. Current guidelines lack robust multidimensional tools for predicting in-hospital adverse outcomes. OBJECTIVE: To develop and validate the Asthma Outcome Risk Index for Hospitalized Patients (AORI-HAP), integrating multidimensional predictors, and investigate immune-inflammatory mechanisms underlying adverse outcomes. METHODS: This real-world cohort study enrolled hospitalized AE patients. Univariate analyses identified associations between multidimensional biomarkers and composite outcome (death, ICU admission, invasive ventilation). LASSO logistic regression derived the AORI-HAP, stratifying patients into risk categories. Mediation analysis elucidated mechanistic contributions to adverse outcomes. RESULTS: The AORI-HAP identified five independent predictors of adverse outcomes: elevated neutrophil-to-lymphocyte ratio (NLR?>?8.3, OR?=?9.26, p?<?0.001), increased AST/ALT ratio (>1.41, OR?=?3.73, p?<?0.001), smoking history ?10 pack-years (OR?=?3.54, p?=?0.005), D-Dimer levels ?5?mg/L (OR?=?3.25, p?=?0.002), and fasting glucose ?7?mmol/L (OR?=?3.20, p?=?0.001). Each 3-point increment in the AORI-HAP score corresponded to an additional hospital day (? = 0.997, 95% CI: 0.78-1.21, p?<?0.001), with the model demonstrating strong predictive performance (AUC 0.91, 95% CI 0.86-0.95; sensitivity 90.5%, specificity 69.6%). Mediation analysis revealed that NLR accounted for 26.7% of the total effect linking high-risk status to composite adverse outcome, underscoring its mechanistic relevance. CONCLUSION: AORI-HAP facilitates early risk stratification at admission and personalized management in hospitalized asthma patients. NLR's mediating role underscores its utility as a predictive biomarker and potential therapeutic target.
AU  - Yuan, L
AU  - Zhao, C
AU  - Wang, L
AU  - Zhang, L
AU  - Liu, Y
AU  - Liu, L
AU  - Feng, M
AU  - Melén, E
AU  - Wang, G
AU  - Zhang, S
AU  - Yuan, Y
AU  - Wang, Q
AU  - Li, Y
AU  - Kang, D
AU  - Zhang, X
DA  - 2025
DO  - 10.3389/fmed.2025.1707866
JO  - Front Med (Lausanne)
PB  - Frontiers
PY  - 2025
SP  - 1707866
TI  - AORI-HAP: a multidimensional risk index to predict in-hospital adverse outcomes in asthma exacerbations.
VL  - 12
Y1  - 2025
Y2  - 2026/06/30
ER  -