{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,13]],"date-time":"2026-05-13T17:04:42Z","timestamp":1778691882788,"version":"3.51.4"},"reference-count":27,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,2,11]],"date-time":"2026-02-11T00:00:00Z","timestamp":1770768000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Endocrinol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) carries substantial short-term mortality. Whether type 2 diabetes mellitus (T2DM) provides incremental prognostic information for in-hospital death during AECOPD, beyond acute physiological decompensation, remains incompletely defined.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a multicenter retrospective cohort study of consecutive inpatients admitted for AECOPD at three tertiary hospitals (June 2022\u2013December 2024). A multivariable logistic model was developed in the training cohort using routinely available variables obtained early after admission, with feature selection by LASSO and performance evaluation by discrimination, calibration, and decision curve analysis. External validation was performed in an independent hospital cohort with intercept\/slope recalibration when indicated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among 4,292 patients (training n=2,861; external n=1,431), patients with T2DM had higher in-hospital mortality than those without T2DM. In the multivariable model, T2DM contributed incremental prognostic information for in-hospital death (adjusted OR = 2.74, 95% CI 1.62\u20134.56), together with PaCO\n                      <jats:sub>2<\/jats:sub>\n                      , blood urea nitrogen, neutrophil-to-lymphocyte-to-albumin ratio, C-reactive protein, and age. The resulting six-variable nomogram showed strong discrimination (AUC = 0.843 training; 0.817 external), low overall prediction error (external Brier\u22480.025), and clinically meaningful net benefit across 5\u201315% threshold probabilities; calibration in the external cohort was improved to near-ideal after recalibration.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In hospitalized AECOPD, T2DM provides clinically relevant incremental prognostic information for short-term in-hospital mortality within a parsimonious multivariable model. The nomogram may facilitate early risk stratification and support integrated respiratory and metabolic co-management.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fendo.2026.1726502","type":"journal-article","created":{"date-parts":[[2026,2,11]],"date-time":"2026-02-11T05:22:27Z","timestamp":1770787347000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Development and external validation of an admission-based model for in-hospital mortality in acute exacerbation of COPD: incremental prognostic value of type 2 diabetes mellitus"],"prefix":"10.3389","volume":"17","author":[{"given":"Jie","family":"Chen","sequence":"first","affiliation":[{"name":"Department of Respiratory and Critical Care Medicine, The Third Affiliated Hospital of Anhui Medical University (The First People\u2019s Hospital of Hefei)","place":["Hefei, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xiaofeng","family":"Zhang","sequence":"additional","affiliation":[{"name":"General Medicine Department, The Second Affiliated Hospital of Anhui Medical University","place":["Hefei, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kunhe","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Respiratory and Critical Care Medicine, Binhu Hospital of Hefei","place":["Hefei, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wei","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Metabolism, The Third Affiliated Hospital of Anhui Medical University (The First People\u2019s Hospital of Hefei)","place":["Hefei, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mingmei","family":"Zhong","sequence":"additional","affiliation":[{"name":"Department of Respiratory and Critical Care Medicine, The Third Affiliated Hospital of Anhui Medical University (The First People\u2019s Hospital of Hefei)","place":["Hefei, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,2,11]]},"reference":[{"key":"B1","unstructured":"Chronic obstructive pulmonary disease (COPD)\n          \n          \n          \n          2024"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1186\/s12931-024-03051-2","article-title":"Global, regional, and national burden of chronic obstructive pulmonary disease and its attributable risk factors from 1990 to 2021: an analysis for the Global Burden of Disease Study 2021","volume":"26","author":"Wang","year":"2025","journal-title":"Respir Res"},{"key":"B3","unstructured":"Pocket Guide to COPD Diagnosis, Management and Prevention: 2025 Report\n          \n          \n          \n          2025"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.3390\/jcm10020235","article-title":"The impact of diabetes mellitus in patients with chronic obstructive pulmonary disease (COPD) hospitalization","volume":"10","author":"Gunasekaran","year":"2021","journal-title":"J Clin Med"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.5603\/cd.95828","article-title":"Prevalence and severity of chronic obstructive pulmonary disease in people with type 2 diabetes: A cross-sectional study","volume":"12","author":"Bera","year":"2023","journal-title":"Clin Diabetol"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.37765\/ajmc.2022.89225","article-title":"Diabetes associated with higher health care utilization and poor outcomes after COPD-related hospitalizations","volume":"28","author":"Belligund","year":"2022","journal-title":"Am J Manag Care"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1007\/s00125-024-06102-x","article-title":"Diabetes and infection: review of the epidemiology, mechanisms and principles of treatment","volume":"67","author":"Holt","year":"2024","journal-title":"Diabetologia"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.2174\/1573399815666191024085838","article-title":"Type 2 diabetes and its impact on the immune system","volume":"16","author":"Berbudi","year":"2020","journal-title":"Curr Diabetes Rev"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.1038\/nm.3887","article-title":"Diabetes primes neutrophils to undergo NETosis, which impairs wound healing","volume":"21","author":"Wong","year":"2015","journal-title":"Nat Med"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.2147\/COPD.S516346","article-title":"Potential causal relationship between chronic obstructive pulmonary disease and diabetes: a bidirectional two-sample Mendelian randomization study","volume":"20","author":"Wang","year":"2025","journal-title":"Int J Chron Obstruct Pulmon Dis"},{"key":"B11","doi-asserted-by":"publisher","first-page":"3991","DOI":"10.1183\/13993003.erj.38.Suppl_55.p3991","article-title":"Systemic inflammation is enhanced by acute hyperglycaemia and suppressed by insulin in COPD","volume":"38","author":"Archer","year":"2014","journal-title":"Eur Respir J"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.1186\/s12931-020-01607-6","article-title":"Outcomes associated with comorbid diabetes among patients with COPD exacerbation: findings from the ACURE registry","volume":"22","author":"Mao","year":"2021","journal-title":"Respir Res"},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.1007\/s40200-021-00766-7","article-title":"Characteristics and outcomes of diabetic patients with acute exacerbation of COPD","volume":"20","author":"Monsour","year":"2021","journal-title":"J Diabetes Metab Disord"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.1186\/s12890-020-01371-9","article-title":"Analysis of prevalence and prognosis of type 2 diabetes mellitus in patients with acute exacerbation of COPD","volume":"21","author":"Lin","year":"2021","journal-title":"BMC Pulm Med"},{"key":"B15","unstructured":"ICD-10-CM\/PCS MS-DRG v43.0 Definitions Manual: MDC 04 Diseases and Disorders of the Respiratory System - Chronic Obstructive Pulmonary Disease\n          \n          \n          \n          2025"},{"key":"B16","doi-asserted-by":"publisher","DOI":"10.2337\/dc24-S002","article-title":"2. Diagnosis and classification of diabetes: Standards of Care in Diabetes-2024","volume":"47","year":"2024","journal-title":"Diabetes Care"},{"key":"B17","doi-asserted-by":"publisher","DOI":"10.1007\/s00508-018-1364-6","article-title":"Long-term outcomes after acute hypercapnic COPD exacerbation: first-ever episode of non-invasive ventilation","volume":"130","author":"Fazekas","year":"2018","journal-title":"Wien Klin Wochenschr"},{"key":"B18","doi-asserted-by":"publisher","DOI":"10.5152\/TurkThoracJ.2018.18036","article-title":"High prevalence of diabetes mellitus in a cohort of patients with chronic obstructive pulmonary disease in Trinidad, West Indies","volume":"20","author":"Rambaran","year":"2019","journal-title":"Turk Thorac J"},{"key":"B19","doi-asserted-by":"publisher","DOI":"10.4081\/monaldi.2023.2776","article-title":"Diabetes mellitus in acute exacerbation of chronic obstructive pulmonary disease - the tip of the iceberg","volume":"94","author":"Tayal","year":"2024","journal-title":"Monaldi Arch Chest Dis"},{"key":"B20","doi-asserted-by":"publisher","DOI":"10.1155\/2021\/3187388","article-title":"Prevalence and clinical significance of occult pulmonary infection in elderly patients with type 2 diabetes mellitus","volume":"2021","author":"Hua","year":"2021","journal-title":"BioMed Res Int"},{"key":"B21","doi-asserted-by":"publisher","DOI":"10.1155\/2022\/3247807","article-title":"Correlation between hs-CRP, IL-6, IL-10, ET-1, and chronic obstructive pulmonary disease combined with pulmonary hypertension","volume":"2022","author":"Yang","year":"2022","journal-title":"J Healthc Eng"},{"key":"B22","doi-asserted-by":"publisher","DOI":"10.2337\/db22-0114","article-title":"BAF60a deficiency in macrophage promotes diet-induced obesity and metabolic inflammation","volume":"71","author":"Kong","year":"2022","journal-title":"Diabetes"},{"key":"B23","doi-asserted-by":"publisher","first-page":"79","DOI":"10.59556\/japi.72.0573","article-title":"Responsible use of oral corticosteroids in people with comorbid diabetes: an expert consensus","volume":"72","author":"Saboo","year":"2024","journal-title":"J Assoc Phys India"},{"key":"B24","doi-asserted-by":"publisher","DOI":"10.1177\/14799731251325251","article-title":"Clinical characteristics and prognosis prediction in patients with AECOPD and type 2 diabetes mellitus: a multicenter observational study","volume":"22","author":"Li","year":"2025","journal-title":"Chron Respir Dis"},{"key":"B25","doi-asserted-by":"publisher","DOI":"10.1136\/thoraxjnl-2012-202103","article-title":"The DECAF Score: predicting hospital mortality in exacerbations of chronic obstructive pulmonary disease","volume":"67","author":"Steer","year":"2012","journal-title":"Thorax"},{"key":"B26","doi-asserted-by":"publisher","DOI":"10.1186\/1465-9921-15-30","article-title":"Hypo- and hypercapnia predict mortality in oxygen-dependent chronic obstructive pulmonary disease: a population-based prospective study","volume":"15","author":"Ahmadi","year":"2014","journal-title":"Respir Res"},{"key":"B27","doi-asserted-by":"publisher","DOI":"10.1080\/15412555.2021.1902491","article-title":"Glycated hemoglobin (HbA1c) as a predictor of outcomes during acute exacerbations of chronic obstructive pulmonary disease","volume":"18","author":"Papathanassiou","year":"2021","journal-title":"COPD"}],"container-title":["Frontiers in Endocrinology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fendo.2026.1726502\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,11]],"date-time":"2026-02-11T05:22:28Z","timestamp":1770787348000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fendo.2026.1726502\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,11]]},"references-count":27,"alternative-id":["10.3389\/fendo.2026.1726502"],"URL":"https:\/\/doi.org\/10.3389\/fendo.2026.1726502","relation":{},"ISSN":["1664-2392"],"issn-type":[{"value":"1664-2392","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,11]]},"article-number":"1726502"}}