Immune-inflammatory profiles are associated with exercise capacity and psychological status in hospitalized patients with acute exacerbation of COPD

To examine the associations between immune-inflammatory status and exercise capacity and psychological status in hospitalized patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD), and to inform multidimensional patient characterization. In this cross-sectional study, consecutively hospitalized patients with AECOPD were enrolled and classified into Grade I, II, and III according to predefined severity criteria. General clinical data were collected. Peripheral blood T-lymphocyte subsets (CD3⁺%, CD4⁺%, CD8⁺%, and CD4⁺/CD8⁺ ratio) and inflammatory markers (IL-6, IL-8, TNF-α, WBC, and hs-CRP) were measured. Exercise capacity, symptom burden, psychological status, and activities of daily living were assessed using the 6-minute walk test (6MWT), modified Medical Research Council (mMRC) dyspnea scale, Borg scale, COPD Assessment Test (CAT), Hospital Anxiety and Depression Scale (HADS), and Activities of Daily Living (ADL) scale. Group differences across severity grades were compared, and correlation analyses were performed to evaluate relationships between immune-inflammatory markers and clinical outcomes. Across increasing AECOPD severity grades, CD3⁺% and CD4⁺% decreased, whereas CD8⁺% showed a non-significant increasing trend. Inflammatory markers such as IL-8, WBC, and hs-CRP increased with severity grade, whereas IL-6 and TNF-α did not show significant overall differences across the three groups. The 6MWT distance decreased with higher severity grade, and Borg, CAT, HADS-A, and HADS-D scores increased. mMRC and ADL did not show statistically significant overall differences across severity grades. CD4⁺% and the CD4⁺/CD8⁺ ratio were positively correlated with 6MWT distance and negatively correlated with CAT, while CD8⁺% was negatively correlated with 6MWT distance and ADL and positively correlated with CAT.Among inflammatory markers, several showed significant correlations with 6MWT distance, Borg, CAT, and selected psychological or ADL outcomes, while others were non-significant. In hospitalized AECOPD patients, immune-inflammatory profiles varied across severity grades and were associated with exercise capacity, symptom burden, psychological status, and daily functioning. Integrating immune-inflammatory markers with functional and psychological assessments may support more comprehensive characterization of patients. Prospective multicenter studies are warranted to evaluate prognostic utility and clarify temporal relationships.