Predictive Nomogram for Severe COVID-19 and Identification of Mortality-Related Immune Features.
J Allergy Clin Immunol Pract
; 9(1): 177-184.e3, 2021 01.
Article
in English
| MEDLINE | ID: covidwho-907075
ABSTRACT
BACKGROUND:
Patients with severe 2019 novel coronavirus disease (COVID-19) have a high mortality rate. The early identification of severe COVID-19 is of critical concern. In addition, the correlation between the immunological features and clinical outcomes in severe cases needs to be explored.OBJECTIVE:
To build a nomogram for identifying patients with severe COVID-19 and explore the immunological features correlating with fatal outcomes.METHODS:
We retrospectively enrolled 85 and 41 patients with COVID-19 in primary and validation cohorts, respectively. A predictive nomogram based on risk factors for severe COVID-19 was constructed using the primary cohort and evaluated internally and externally. In addition, in the validation cohort, immunological features in patients with severe COVID-19 were analyzed and correlated with disease outcomes.RESULTS:
The risk prediction nomogram incorporating age, C-reactive protein, and D-dimer for early identification of patients with severe COVID-19 showed favorable discrimination in both the primary (area under the curve [AUC] 0.807) and validation cohorts (AUC 0.902) and was well calibrated. Patients who died from COVID-19 showed lower abundance of peripheral CD45RO+CD3+ T cells and natural killer cells, but higher neutrophil counts than that in the patients who recovered (P = .001, P = .009, and P = .009, respectively). Moreover, the abundance of CD45RO+CD3+ T cells, neutrophil-to-lymphocyte ratio, and neutrophil-to-natural killer cell ratio were strong indicators of death in patients with severe COVID-19 (AUC 0.933 for all 3).CONCLUSION:
The novel nomogram aided the early identification of severe COVID-19 cases. In addition, the abundance of CD45RO+CD3+ T cells and neutrophil-to-lymphocyte and neutrophil-to-natural killer cell ratios may serve as useful prognostic predictors in severe patients.Keywords
Full text:
Available
Collection:
International databases
Database:
MEDLINE
Main subject:
Nomograms
/
COVID-19
Type of study:
Cohort study
/
Experimental Studies
/
Observational study
/
Prognostic study
Limits:
Aged
/
Female
/
Humans
/
Male
/
Middle aged
Language:
English
Journal:
J Allergy Clin Immunol Pract
Year:
2021
Document Type:
Article
Affiliation country:
J.jaip.2020.10.043
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