ORIGINAL RESEARCH article
Front. Med.
Sec. Pulmonary Medicine
AORI-HAP: A Multidimensional Risk Index to Predict In-Hospital Adverse Outcomes in Asthma Exacerbations
Provisionally accepted
Lishan Yuan1Chongyang Zhao1Lei Wang1Li Zhang1Ying Liu1Lei Liu1
Min Feng2
Erik Melén3Gang Wang3
Shuwen Zhang4
Yulai Yuan5
Qin Wang1Yilai Li1
Deying Kang1
Xin Zhang1*- 1West China Hospital of Sichuan University, Chengdu, China
- 2University of Technology Sydney, Sydney, Australia
- 3Karolinska Institutet, Stockholm, Sweden
- 4China-Japan Friendship Hospital Department of Pulmonary and Critical Care Medicine, Beijing, China
- 5Southwest Medical University, Luzhou, China
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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 outcomes (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 (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 outcomes, underscoring its mechanistic relevance. Conclusions: AORI-HAP facilitates early risk stratification at admission and
Keywords: AORI-HAP, Asthma exacerbations, immunoinflammatory mechanisms, multidimensional risk assessment, Predictive scoring system
Received: 18 Sep 2025; Accepted: 27 Nov 2025.
Copyright: © 2025 Yuan, Zhao, Wang, Zhang, Liu, Liu, Feng, Melén, Wang, Zhang, Yuan, Wang, Li, Kang and Zhang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Xin Zhang
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