AORI-HAP: a multidimensional risk index to predict in-hospital adverse outcomes in asthma exacerbations
Year: 2025
Type: article
Study design: Observational Study
Abstract: 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 ( β = 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.
Source: Frontiers in Medicine
Authors: Lishan Yuan, Chongyang Zhao, Lei Wang, Li Zhang, Ying Liu, Lei Liu, Min Feng, Erik Melén, Gang Wang, Shuwen Zhang, Yulai Yuan, Qin Wang, Yilai Li, Deying Kang, Xin Zhang
Institutions: Sichuan University, West China Hospital of Sichuan University, University of Technology Sydney, Woolcock Institute of Medical Research, Karolinska Institutet, Stockholm South General Hospital, China-Japan Friendship Hospital, Southwest Medical University, Affiliated Hospital of Southwest Medical University
Language: English
Subfield: Physiology
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $3,801
OpenAlex ID: W4417180975