To investigate inflammatory-metabolic biomarker profiles associated with asthma-chronic obstructive pulmonary disease overlap (ACO) and to identify biomarkers that differentiate ACO from COPD.
Approach:
Cohorts: A two-cohort study was conducted using NHANES as the primary cohort and a hospital-based cohort from Chengdu as a complementary cohort.
Data Analysis: Participants were classified into non-asthma/COPD, asthma-only, COPD-only, and ACO groups. Weighted comparisons, pairwise analyses, multinomial logistic regression, VIF analysis, and LASSO regression were performed.
Key Findings:
Pairwise comparisons showed that several metabolic biomarkers, particularly CTI, RCII, RFM, and LAP, remained significantly elevated in ACO compared with COPD alone.
In multinomial logistic regression analyses, higher levels of inflammatory biomarkers (CLR, NLR, ELR, MLR, SII, and SIRI) and metabolic biomarkers (TyG and its derived indices, RFM, LAP, CTI, and RCII) remained significantly associated with ACO, whereas CALLY was inversely associated with ACO.
In the hospital-based cohort, LASSO regression selected TyG, AIP, CTI, MLR, and CLR. The combination of TyG, AIP, CTI, and MLR achieved the highest AUC (0.583, 95% CI 0.551–0.615).
Interpretation:
ACO was associated with inflammatory-metabolic alterations compared with COPD.
Limitations:
The discriminatory performance of biomarker models was modest.
The study may not fully capture the multifactorial nature of ACO.
Conclusion:
Findings from both cohorts suggest an association between inflammatory-metabolic disturbances and the biological heterogeneity of ACO.
