AORI-HAP: a multidimensional risk index to predict in-hospital adverse outcomes in asthma exacerbations

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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.

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