IJCM  Vol.11 No.12 , December 2020
A Nomogram for Predicting the Severity of COVID-19 Using Laboratory Examination and CT Findings
Abstract: Background: The outbreak of COVID-19 has a significant impact on the health of people around the world. In the clinical condition of COVID-19, the condition of critical cases changes rapidly with a high mortality rate. Therefore, early prediction of disease severity and active intervention play an important role in the prognosis of severe patients. Methods: All the patients with COVID-19 in Taizhou city were retrospectively included and segregated into the non-severe and severe group according to the severity of the disease. The clinical manifestations, laboratory examination results, and imaging findings of the 2 groups were analyzed for comparing the differences between the 2 groups. Univariate and multivariate logistic regression were used for screening the factors that could predict the disease, and the nomogram was constructed. Results: A total of 143 laboratory-confirmed cases were included in the study, including 110 non-severe patients and 33 severe patients. The median age of patients was 47 years (range, 4 - 86 years). Fever (73.4%) and cough (63.6%) were the most common initial clinical symptoms. By using the method of multivariate logistic regression, the variables to construct nomogram include age (OR: 1.052, 95% CI: 1.020 - 1.086, P = 0.001), body temperature (OR: 2.252, 95% CI: 1.139 - 4.450, P = 0.020), lymphocyte count (OR: 1.128, 95% CI: 1.000 - 1.272, P = 0.049), ADA (OR: 1.163, 95% CI: 1.023 - 1.323, P = 0.021), PaO2 (OR: 0.972, 95% CI: 0.953 - 0.992, P = 0.007), IL-10 (OR: 1.184, 95% CI: 1.037 - 1.351, P = 0.012), and bronchiectasis (OR: 3.818, 95% CI: 1.694 - 8.605, P = 0.001). The AUC of the established nomogram was 0.877. Conclusions: This study analyzed the cases of patients with COVID-19 in Taizhou city and constructed a model to predict the illness severity. When patients showed the features including older age, high body temperature, low lymphocyte count, low ADA value, low PaO2, high IL-10, and bronchiectasis sign in CT predicts a greater likelihood of severe COVID-19.
Cite this paper: Kuang, Y. , He, S. , Lin, S. , Zhu, R. , Zhou, R. , Wang, J. , Li, R. , Lin, H. , Zhang, Z. , Pang, P. and Ji, W. (2020) A Nomogram for Predicting the Severity of COVID-19 Using Laboratory Examination and CT Findings. International Journal of Clinical Medicine, 11, 786-809. doi: 10.4236/ijcm.2020.1112059.

[1]   Wang, W., Tang, J. and Wei, F. (2020) Updated Understanding of the Outbreak of 2019 Novel Coronavirus (2019-nCoV) in Wuhan, China. Journal of Medical Virology, 92, 441-447.

[2]   Hui, D.S., Azhar, I.E., Madani, T.A., Ntoumi, F., Kock, R., Dar, O., et al. (2020) The Continuing 2019-nCoV Epidemic Threat of Novel Coronaviruses to Global Health: The Latest 2019 Novel Coronavirus Outbreak in Wuhan, China. International Journal of Infectious Diseases, 91, 264-266.

[3]   Bassetti, M., Vena, A. and Roberto, G.D. (2020) The Novel Chinese Coronavirus (2019-nCoV) Infections: Challenges for Fighting the Storm. European Journal of Clinical Investigation, 50, e13209.

[4]   Lu, R., Zhao, X., Li, J., Niu, P., Yang, B., Wu, H., et al. (2020) Genomic Characterisation and Epidemiology of 2019 Novel Coronavirus: Implications for Virus Origins and Receptor Binding. The Lancet, 395, 565-574.

[5]   Rothe, C., Schunk, M., Sothmann, P., Bretzel, G., Froeschl, G., Wallrauch, C., et al. (2020) Transmission of 2019-nCoV Infection from an Asymptomatic Contact in Germany. New England Journal of Medicine, 382, 970-971.

[6]   Phan, L.T., Nguyen, T.V., Luong, Q.C., Nguyen, T.V., Nguyen, H.T., Le, H.Q., et al. (2020) Importation and Human-to-Human Transmission of a Novel Coronavirus in Vietnam. New England Journal of Medicine, 382, 872-874.

[7]   Chan, J.F.W., Yuan, S., Kok, K.H., To, K.K.W., Chu, H., Yang, J., et al. (2020) A Familial Cluster of Pneumonia Associated with the 2019 Novel Coronavirus Indicating Person-to-Person Transmission: A Study of a Family Cluster. The Lancet, 395, 514-523.

[8]   Wu, J.T., Leung, K. and Leung, G.M. (2020) Nowcasting and Forecasting the Potential Domestic and International Spread of the 2019-nCoV Outbreak Originating in Wuhan, China: A Modelling Study. The Lancet, 395, 689-697.

[9]   China D. Dingxiang Garden, Doctor Dingxiang, Real-Time Status of New Coronavirus Pneumonia. 5.

[10]   Ren, W., Qu, X., Li, W., Han, Z., Yu, M., Zhou, P., et al. (2008) Difference in Receptor Usage between Severe Acute Respiratory Syndrome (SARS) Coronavirus and SARS-Like Coronavirus of Bat Origin. Journal of Virology, 82, 1899-1907.

[11]   Maier, H.J., Bickerton, E. and Britton, P. (2015) Coronaviruses: An Overview of Their Replication and Pathogenesis. Coronaviruses—Methods and Protocols, 1282, 1-23.

[12]   Hemida, M.G., Elmoslemany, A., Al-hizab, F., Alnaeem, A., Almathen, F., Faye, B., et al. (2018) Dromedary Camels and the Transmission of Middle East Respiratory Syndrome Coronavirus (MERS-CoV). Transboundary and Emerging Diseases, 64, 344-353.

[13]   Kucharski, A.J. and Althaus, C.L. (2015) The Role of Superspreading in Middle East Respiratory Syndrome Coronavirus (MERS-CoV) Transmission. Eurosurveillance, 20, 14-18.

[14]   Mackay, I.M. and Arden, K.E. (2015) MERS Coronavirus: Diagnostics, Epidemiology and Transmission. Virology Journal, 12, Article No. 222.

[15]   Azhar, E.I., Hui, D.S.C., Memish, Z.A., Drosten, C. and Zumla, A. (2019) The Middle East Respiratory Syndrome (MERS). Infectious Disease Clinics of North America, 33, 891-905.

[16]   Lim, J., Jeon, S., Shin, H.Y., Kim, M.J., Seong, Y.M., Lee, W.J., et al. (2020) Case of the Index Patient Who Caused Tertiary Transmission of COVID-19 Infection in Korea: The Application of Lopinavir/Ritonavir for the Treatment of COVID-19 Infected Pneumonia Monitored by Quantitative RT-PCR. Journal of Korean Medical Science, 35, e79.

[17]   COVID-19 National Incident Room Surveillance Team (2020) COVID-19, Australia: Epidemiology Report 2 (Reporting Week Ending 19:00 AEDT 8 February 2020). Communicable Diseases Intelligence, 12, 44.

[18]   Status, C., Ahn, D., Shin, H., Kim, M., Lee, S., Kim, H., et al. (2020) Current Status of Epidemiology, Diagnosis, Therapeutics, and Vaccines for Novel Coronavirus Disease 2019 (COVID-19). Journal of Microbiolog and Biotechnology, 30, 313-324.

[19]   New Coronavirus Diagnosis and Treatment Protocol (Trial Version 5). Chinese Journal of Integrated Traditional and Western Medicine, 1-3.

[20]   Zhang, S.Y., Lian, J.S., Hu, J.H., Zhang, X.L., Lu, Y.F., Cai, H., et al. (2020) Clinical Characteristics of Different Subtypes and Risk Factors for the Severity of Illness in Patients with COVID-19 in Zhejiang, China. Infectious Diseases of Poverty, 9, Article No. 85.

[21]   Lian, J., Jin, X., Hao, S., Jia, H., Cai, H., Zhang, X., et al. (2020) Epidemiological, Clinical, and Virological Characteristics of 465 Hospitalized Cases of Coronavirus Disease 2019 (COVID-19) from Zhejiang Province in China. Influenza and Other Respiratory Viruses, 14, 564-574.

[22]   Wang, S., Chen, Z., Lin, Y., Lin, L., Lin, Q., Fang, S., et al. (2020) Clinical Characteristics of 199 Discharged Patients with COVID-19 in Fujian Province: A Multicenter Retrospective Study between January 22nd and February 27th, 2020. PLoS ONE, 15, e0242307.

[23]   Jin, X., Lian, J.S., Hu, J.H., Gao, J., Zheng, L., Zhang, Y.M., et al. (2020) Epidemiological, Clinical and Virological Characteristics of 74 Cases of Coronavirus-Infected Disease 2019 (COVID-19) with Gastrointestinal Symptoms. Gut, 69, 1002-1009.

[24]   Guan, W.-J., Ni, Z.-Y., Hu, Y., Liang, W.-H., Ou, C.-Q., He, J.-X., et al. (2020) Clinical Characteristics of Coronavirus Disease 2019 in China. New England Journal of Medicine, 382, 1708-1720.

[25]   Chen, N., Zhou, M., Dong, X., Qu, J., Gong, F., Han, Y., et al. (2020) Epidemiological and Clinical Characteristics of 99 Cases of 2019 Novel Coronavirus Pneumonia in Wuhan, China: A Descriptive Study. The Lancet, 395, 507-513.

[26]   Li, Q., Guan, X., Wu, P., Wang, X., Zhou, L., Tong, Y., et al. (2020) Early Transmission Dynamics in Wuhan, China, of Novel Coronavirus-Infected Pneumonia. New England Journal of Medicine, 1-9.

[27]   Wang, D., Hu, B., Hu, C., Zhu, F., Liu, X., Zhang, J., et al. (2020) Clinical Characteristics of 138 Hospitalized Patients with 2019 Novel Coronavirus-Infected Pneumonia in Wuhan, China. JAMA, 323, 1061-1069.

[28]   Liu, W.J., Zhao, M., Liu, K., Xu, K., Wong, G., Tan, W., et al. (2017) T-Cell Immunity of SARS-CoV: Implications for Vaccine Development against MERS-CoV. Antiviral Research, 137, 82-92.

[29]   Saghazadeh, A. and Rezaei, N. (2020) Immune-Epidemiological Parameters of the Novel Coronavirus—A Perspective. Expert Review of Clinical Immunology, 16, 465-470.

[30]   Pinsky, M.R. (2004) Dysregulation of the Immune Response in Severe Sepsis. The American Journal of the Medical Sciences, 328, 220-229.

[31]   Huang, C., Wang, Y., Li, X., Ren, L., Zhao, J., Hu, Y., et al. (2020) Clinical Features of Patients Infected with 2019 Novel Coronavirus in Wuhan, China. The Lancet, 395, 497-506.

[32]   Qin, C., Zhou, L., Hu, Z., Zhang, S., Yang, S., Tao, Y., et al. (2020) Dysregulation of Immune Response in Patients with COVID-19 in Wuhan, China. SSRN Electronic Journal.

[33]   Agosto, L.M. and Henderson, A.J. (2018) CD4+ T Cell Subsets and Pathways to HIV Latency. AIDS Research and Human Retroviruses, 34, 780-789.

[34]   Akiyama, H., Miller, C.M., Ettinger, C.R., Belkina, A.C., Snyder-Cappione, J.E. and Gummuluru, S. (2018) HIV-1 Intron-Containing RNA Expression Induces Innate Immune Activation and T Cell Dysfunction. Nature Communications, 9, 3450.

[35]   Yang, W., Cao, Q., Qin, L., Wang, X., Cheng, Z., Pan, A., et al. (2020) Clinical Characteristics and Imaging Manifestations of the 2019 Novel Coronavirus Disease (COVID-19): A Multi-Center Study in Wenzhou City, Zhejiang, China. Journal of Infection, 80, 388-393.

[36]   Wang, F., Qu, M., Zhou, X., Zhao, K., Lai, C., Tang, Q., et al. (2020) The Timeline and Risk Factors of Clinical Progression of COVID-19 in Shenzhen, China. Journal of Translational Medicine, 18, Article No. 270.