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Updated: May 12, 2026
Characterization of Immune Cells and Proinflammatory Mediators in the Pulmonary Environment
Published on: June 24, 2020
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.
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