The study developed and validated the AORI-HAP multidimensional risk index to predict adverse outcomes during hospitalization of patients with asthma exacerbations. The index includes five independent predictors: neutrophil-to-lymphocyte ratio (NLR > 8.3), AST/ALT ratio > 1.41, smoking history, D-dimer levels ≥ 5 mg/L, and fasting glucose ≥ 7 mmol/L. Each 3-point increase in the score was correlated with a one-day longer hospital stay. The model achieved high accuracy in predicting adverse outcomes with an AUC of 0.91. Median analysis showed that NLR explained 26.7% of the overall risk of adverse outcomes, highlighting its importance as a biomarker and potential therapeutic target. AORI-HAP enables early risk stratification and personalized management of hospitalized patients with asthma. The results support the use of immune-inflammatory indicators in the assessment of the severity of asthma exacerbations.