{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T06:46:22Z","timestamp":1782283582689,"version":"3.54.5"},"reference-count":30,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T00:00:00Z","timestamp":1782259200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Science and Technology Department of Sichuan Province-International Science and Technology Innovation Cooperation Project","award":["2024YFHZ0273"],"award-info":[{"award-number":["2024YFHZ0273"]}]},{"name":"Noncommunicable Chronic Diseases-National Science and Technology Major Project","award":["2023ZD0506603"],"award-info":[{"award-number":["2023ZD0506603"]}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>The prognostic significance of the computed tomography (CT)-defined emphysema phenotype in patients hospitalized with mild-to-moderate acute exacerbation of chronic obstructive pulmonary disease (AECOPD) remains poorly defined.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and methods<\/jats:title>\n                    <jats:p>This prospective multicenter cohort study analyzed data from the MAGNET AECOPD Registry. We included patients hospitalized with mild-to-moderate AECOPD (Rome criteria) who underwent chest CT within 24\u202fh of admission. Participants were categorized into emphysema and non-emphysema groups based on visual CT assessment. The primary outcome was 3-year all-cause mortality; secondary outcomes included rehospitalization and in-hospital events. Propensity score matching balanced baseline characteristics.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among 5,713 eligible patients, 4,558 (79.8%) had emphysema. After 1:1 propensity score matching (\n                      <jats:italic>n<\/jats:italic>\n                      \u202f=\u202f2,258), the emphysema group demonstrated more severe acute disease, with higher proportions of respiratory failure (12.1% vs. 3.4%,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.001), and elevated inflammatory markers (all\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.001). Interestingly, the emphysema group exhibited significantly lower 3-year all-cause mortality (24.8% vs. 30.2%, log-rank\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.048) despite higher rates of non-invasive ventilation requirement (24.1% vs. 19.1%,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.005) and longer hospital stays (11 vs. 10\u202fdays,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.001). The non-emphysema group carried a heavier burden of cardiovascular comorbidities including hypertension (41.5% vs. 32.7%,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.001) and heart failure (18.7% vs. 13.6%,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In mild-to-moderate AECOPD, the emphysema phenotype predicts higher acute morbidity yet lower long-term mortality. This finding suggests potential distinct pathophysiological pathways and supports further investigation of CT-based phenotyping for personalized management in COPD.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Clinical trial registration<\/jats:title>\n                    <jats:p>\n                      <jats:ext-link>http:\/\/www.chictr.org.cn\/showproj.aspx?proj=121626<\/jats:ext-link>\n                      , Identifier ChiCTR2100044625.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2026.1853642","type":"journal-article","created":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T05:46:41Z","timestamp":1782280001000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Clinical and prognostic differences in mild to moderate AECOPD with and without emphysema: a 3-year multicenter prospective study"],"prefix":"10.3389","volume":"13","author":[{"given":"Jiaqi","family":"Pu","sequence":"first","affiliation":[{"name":"Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University","place":["Chengdu, Sichuan, China"]},{"name":"State Key Laboratory of Respiratory Health and Multimorbidity, West China Hospital, Sichuan University","place":["Chengdu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mingjing","family":"Yu","sequence":"additional","affiliation":[{"name":"Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University","place":["Chengdu, Sichuan, China"]},{"name":"State Key Laboratory of Respiratory Health and Multimorbidity, West China Hospital, Sichuan University","place":["Chengdu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hailong","family":"Wei","sequence":"additional","affiliation":[{"name":"Department of Respiratory and Critical Care Medicine, People's Hospital of Leshan","place":["Leshan, Sichuan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Huiqing","family":"Ge","sequence":"additional","affiliation":[{"name":"Department of Respiratory and Critical Care Medicine, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine","place":["Hangzhou, Zhejiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Huiguo","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Respiratory and Critical Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology","place":["Wuhan, Hubei, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jianchu","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Respiratory and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology","place":["Wuhan, Hubei, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pinhua","family":"Pan","sequence":"additional","affiliation":[{"name":"Department of Respiratory and Critical Care Medicine, Xiangya Hospital, Central South University","place":["Changsha, Hunan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"XiuFang","family":"Xie","sequence":"additional","affiliation":[{"name":"Department of Respiratory and Critical Care Medicine, The First People\u2019s Hospital of Neijiang City","place":["Neijiang, Sichuan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mengqiu","family":"Yi","sequence":"additional","affiliation":[{"name":"Department of Emergency, First People's Hospital of Jiujiang","place":["Jiujiang, Jiangxi, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xianhua","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Respiratory and Critical Care Medicine, The First People\u2019s Hospital of Neijiang City","place":["Neijiang, Sichuan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lina","family":"Cheng","sequence":"additional","affiliation":[{"name":"Department of Emergency, First People's Hospital of Jiujiang","place":["Jiujiang, Jiangxi, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hui","family":"Zhou","sequence":"additional","affiliation":[{"name":"Department of Respiratory and Critical Care Medicine, The Affiliated Hospital of Chengdu University","place":["Chengdu, Sichuan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiarui","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University","place":["Chengdu, Sichuan, China"]},{"name":"State Key Laboratory of Respiratory Health and Multimorbidity, West China Hospital, Sichuan University","place":["Chengdu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiaxin","family":"Zeng","sequence":"additional","affiliation":[{"name":"Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University","place":["Chengdu, Sichuan, China"]},{"name":"State Key Laboratory of Respiratory Health and Multimorbidity, West China Hospital, Sichuan University","place":["Chengdu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xueqing","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University","place":["Chengdu, Sichuan, China"]},{"name":"State Key Laboratory of Respiratory Health and Multimorbidity, West China Hospital, Sichuan University","place":["Chengdu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haixia","family":"Zhou","sequence":"additional","affiliation":[{"name":"Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University","place":["Chengdu, Sichuan, China"]},{"name":"State Key Laboratory of Respiratory Health and Multimorbidity, West China Hospital, Sichuan University","place":["Chengdu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qun","family":"Yi","sequence":"additional","affiliation":[{"name":"Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University","place":["Chengdu, Sichuan, China"]},{"name":"Sichuan Cancer Hospital, University of Electronic Science and Technology of China","place":["Chengdu, Sichuan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,6,24]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"020415","DOI":"10.7189\/jogh.05.020415","article-title":"Global and regional estimates of COPD prevalence: systematic review and 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