TY  - JOUR
AB  - BACKGROUND: Hospitalization due to exacerbations of chronic obstructive pulmonary disease (ECOPD) is linked to substantial mortality rates. OBJECTIVE: This study aimed to identify the clinical and inflammatory phenotypes of patients with ECOPD, as well as to examine their associations with in-hospital outcomes. We sought to explore the underlying mechanisms that contribute to the relationship between ECOPD phenotypes and these outcomes. METHODS: A k-means cluster analysis was conducted on 20,890 recruited patients hospitalized for ECOPD. Logistic regression analyses were utilized to evaluate the associations between the identified phenotypes and in-hospital outcomes, such as mortality, invasive mechanical ventilation (IMV), and intensive care unit (ICU) admission. Additionally, a mediation analysis was performed to elucidate the immunoinflammatory mechanisms underlying the relationship between ECOPD phenotypes and in-hospital outcomes. RESULTS: Three distinct phenotypes were identified: Cluster 1 (n=4,944, 23.67%) exhibited a "Female Eosinophilic Phenotype", Cluster 2 (n=10,814, 51.77%) displayed a "Male Eosinophilic Phenotype", and Cluster 3 (n=5,132, 24.57%) presented as an "Geriatric Multimorbidity-Associated Neutrophilic Systemic Inflammatory Phenotype". Clusters 2 and 3 were associated with higher risks of in-hospital mortality (adjusted odds ratio [ORadj]=1.88 and 17.07, respectively) and IMV (ORadj=2.52 and 7.59, respectively) compared to Cluster 1. Patients in Cluster 3 also experienced an extended hospital stay (median of 13 days) and an increased risk of ICU admission (ORadj=7.72). Additionally, blood eosinophils, neutrophils, CRP, and albumin played a mediating role in the relationship between ECOPD phenotypes and the composite outcome. CONCLUSION: Our study identified three phenotypes stratified by sex, multimorbidity burden, and inflammatory endotypes, which advanced threshold definition for eosinophilic exacerbations and provided prognostic insights for ECOPD management.
AU  - Wang, Q
AU  - Wang, L
AU  - Zhang, L
AU  - Zhao, C
AU  - Liu, Y
AU  - Liu, L
AU  - Yuan, L
AU  - Feng, M
AU  - Wang, G
AU  - Li, L
AU  - Zhang, S
AU  - Yuan, Y
AU  - Kang, D
AU  - Zhang, X
DA  - 2025
DO  - 10.2147/COPD.S505016
EP  - 1624
JO  - International Journal of COPD
PB  - Dove Medical Press
PY  - 2025
SP  - 1613
TI  - Characterizing ECOPD Phenotypes: Associations with In-Hospital Outcomes and Immunoinflammatory Mechanisms.
VL  - 20
Y1  - 2025
Y2  - 2026/08/09
ER  -