{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T09:15:19Z","timestamp":1788340519303,"version":"build-2803163510"},"reference-count":26,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2026,6,23]],"date-time":"2026-06-23T00:00:00Z","timestamp":1782172800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,6,23]],"date-time":"2026-06-23T00:00:00Z","timestamp":1782172800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["82100032"],"award-info":[{"award-number":["82100032"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["82200037"],"award-info":[{"award-number":["82200037"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["82300036"],"award-info":[{"award-number":["82300036"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Respirology"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background and Objectives<\/jats:title>\n                    <jats:p>Exacerbations of asthma\u2013chronic obstructive pulmonary disease overlap (EACO) are associated with high mortality, yet the acute\u2010phase heterogeneity remains poorly characterized. This study aimed to identify distinct inflammatory phenotypes of EACO during hospitalization and evaluate their associations with clinical outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A prospective two\u2010centre cohort study enrolled 2444 EACO patients (training and validation cohort). Baseline inflammatory markers and clinical data were collected. Unsupervised k\u2010means clustering identified inflammatory phenotypes, with sensitivity analysis excluding demographic variables. In\u2010hospital clinical outcomes (ICU admission, invasive ventilation, in\u2010hospital mortality) were assessed. Logistic regression and causal mediation analysis evaluated phenotype\u2013outcome associations. A nomogram was developed and validated using receiver operating characteristic curves (AUC).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Three distinct phenotypes were identified: Cluster T1 (neutrophil\u2010to\u2010lymphocyte ratio [NLR]\u2010elevated hypoeosinophilic systemic inflammatory), Cluster T2 (eosinophilic), and Cluster T3 (eosinophil\u2010neutrophil balanced). Cluster T1 exhibited systemic hyperinflammation (elevated white blood cell count, neutrophils, NLR, C\u2010reactive protein (CRP), procalcitonin (PCT), and interleukin\u20106 (IL\u20106)), and the highest composite adverse outcome rate (24.2%;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). Logistic regression revealed absolute neutrophil count (\u03b2\u2009=\u20090.38,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001), D\u2010dimer (\u03b2\u2009=\u20090.25,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001), and absolute lymphocyte count (\u03b2\u2009=\u2009\u22120.41,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001) as key outcome predictors, confirmed by causal mediation analysis. The nomogram showed robust predictive performance (AUC training\u2009=\u20090.775; validation\u2009=\u20090.766).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Inflammatory phenotypes during EACO predict differential in\u2010hospital outcomes, with neutrophil\u2010dominant phenotypes conferring the highest risk. Early phenotype\u2010based risk stratification using simple blood biomarkers may guide individualized EACO management.<\/jats:p>\n                    <jats:p>\n                      <jats:boxed-text content-type=\"graphic\" position=\"anchor\">\n                        <jats:graphic xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" mimetype=\"image\/png\" position=\"anchor\" specific-use=\"enlarged-web-image\" xlink:href=\"graphic\/resp70275-gra-0001-m.png\">\n                          <jats:alt-text>image<\/jats:alt-text>\n                        <\/jats:graphic>\n                      <\/jats:boxed-text>\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/resp.70275","type":"journal-article","created":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T02:20:33Z","timestamp":1782267633000},"page":"882-892","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Clinical and Inflammatory Phenotypes During Exacerbations Predict In\u2010Hospital Adverse Outcomes in Asthma\u2010\n                    <scp>COPD<\/scp>\n                    Overlap"],"prefix":"10.1002","volume":"31","author":[{"given":"Lishan","family":"Yuan","sequence":"first","affiliation":[{"name":"Division of Internal Medicine Institute of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University  Chengdu China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lei","family":"Wang","sequence":"additional","affiliation":[{"name":"Division of Internal Medicine Institute of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University  Chengdu China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yulai","family":"Yuan","sequence":"additional","affiliation":[{"name":"The Department of Respirology of the Affiliated Traditional Chinese Medicine Hospital Southwest Medical University  Luzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yilai","family":"Li","sequence":"additional","affiliation":[{"name":"Division of Internal Medicine Institute of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University  Chengdu China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Li","family":"Zhang","sequence":"additional","affiliation":[{"name":"Division of Internal Medicine Institute of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University  Chengdu China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ying","family":"Liu","sequence":"additional","affiliation":[{"name":"Division of Internal Medicine Institute of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University  Chengdu 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