Qin Wang, Lei Wang, Li Zhang, Chongyang Zhao, Ying Liu, Lei Liu, Lishan Yuan, Min Feng, Gang Wang, Li Li, Shuwen Zhang, Yulai Yuan, Deying Kang, Xin Zhang
{"title":"表征ECOPD表型：与住院预后和免疫炎症机制的关联","authors":"Qin Wang, Lei Wang, Li Zhang, Chongyang Zhao, Ying Liu, Lei Liu, Lishan Yuan, Min Feng, Gang Wang, Li Li, Shuwen Zhang, Yulai Yuan, Deying Kang, Xin Zhang","doi":"10.2147/COPD.S505016","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Hospitalization due to exacerbations of chronic obstructive pulmonary disease (ECOPD) is linked to substantial mortality rates.</p><p><strong>Objective: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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 [OR<sub>adj</sub>]=1.88 and 17.07, respectively) and IMV (OR<sub>adj</sub>=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 (OR<sub>adj</sub>=7.72). Additionally, blood eosinophils, neutrophils, CRP, and albumin played a mediating role in the relationship between ECOPD phenotypes and the composite outcome.</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":48818,"journal":{"name":"International Journal of Chronic Obstructive Pulmonary Disease","volume":"20 ","pages":"1613-1624"},"PeriodicalIF":2.7000,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12105636/pdf/","citationCount":"0","resultStr":"{\"title\":\"Characterizing ECOPD Phenotypes: Associations with In-Hospital Outcomes and Immunoinflammatory Mechanisms.\",\"authors\":\"Qin Wang, Lei Wang, Li Zhang, Chongyang Zhao, Ying Liu, Lei Liu, Lishan Yuan, Min Feng, Gang Wang, Li Li, Shuwen Zhang, Yulai Yuan, Deying Kang, Xin Zhang\",\"doi\":\"10.2147/COPD.S505016\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Hospitalization due to exacerbations of chronic obstructive pulmonary disease (ECOPD) is linked to substantial mortality rates.</p><p><strong>Objective: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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 [OR<sub>adj</sub>]=1.88 and 17.07, respectively) and IMV (OR<sub>adj</sub>=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 (OR<sub>adj</sub>=7.72). Additionally, blood eosinophils, neutrophils, CRP, and albumin played a mediating role in the relationship between ECOPD phenotypes and the composite outcome.</p><p><strong>Conclusion: </strong>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.</p>\",\"PeriodicalId\":48818,\"journal\":{\"name\":\"International Journal of Chronic Obstructive Pulmonary Disease\",\"volume\":\"20 \",\"pages\":\"1613-1624\"},\"PeriodicalIF\":2.7000,\"publicationDate\":\"2025-05-22\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12105636/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"International Journal of Chronic Obstructive Pulmonary Disease\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.2147/COPD.S505016\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2025/1/1 0:00:00\",\"PubModel\":\"eCollection\",\"JCR\":\"Q2\",\"JCRName\":\"RESPIRATORY SYSTEM\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"International Journal of Chronic Obstructive Pulmonary Disease","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.2147/COPD.S505016","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/1/1 0:00:00","PubModel":"eCollection","JCR":"Q2","JCRName":"RESPIRATORY SYSTEM","Score":null,"Total":0}
Characterizing ECOPD Phenotypes: Associations with In-Hospital Outcomes and Immunoinflammatory Mechanisms.
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.
期刊介绍：
An international, peer-reviewed journal of therapeutics and pharmacology focusing on concise rapid reporting of clinical studies and reviews in COPD. Special focus will be given to the pathophysiological processes underlying the disease, intervention programs, patient focused education, and self management protocols. This journal is directed at specialists and healthcare professionals
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