Introduction
Methods
Study participants
Candidate predictors
Statistical analysis
Results
Patient characteristics
Characteristics | Total(n = 351) | Training dataset (n = 246) | Validation dataset (n = 105) | P valuea |
---|---|---|---|---|
Demographics | ||||
Age (years), median (IQR) | 54(38–66) | 54(38–66.25) | 54(37–65.5) | 0.581 |
Female sex, no. (%) | 162(46.2) | 117(47.6) | 45(42.9) | 0.418 |
Smoking history, n (%) | 57(16.2) | 41(16.7) | 16(15.2) | 0.74 |
Comorbid conditions, n (%) | ||||
Hypertension | 80(22.8) | 53(21.5) | 27(25.7) | 0.407 |
Diabetes mellitus | 41(11.7) | 27(11.0) | 14(13.3) | 0.529 |
Coronary heart disease | 20(5.7) | 13(5.3) | 7(6.7) | 0.609 |
Cerebrovascular diseases | 13(3.7) | 9(3.7) | 4(3.8) | 0.922 |
COPD | 9(2.6) | 7(2.8) | 2(1.9) | 0.73 |
Cancer | 9(2.6) | 9(3.7) | 0(0) | 0.062 |
Immunodeficiency | 1(0.3) | 1(0.4) | 0(0) | 1 |
Laboratory data | ||||
White blood cells (×109/L), median (IQR) | 6.3(5.2–8.4) | 6.35(5.2–8.5) | 6.2(5.25–8.05) | 0.725 |
Neutrophil (×109/L), median (IQR) | 4.21(3.22–6.34) | 4.215(3.2325–6.6425) | 4.17(3.145–6.135) | 0.696 |
Monocyte (×109/L), median (IQR) | 0.21(0.15–0.28) | 0.21(0.14–0.28) | 0.21(0.15–0.27) | 0.953 |
Lymphocyte (×109/L), median (IQR) | 0.91(0.62–1.33) | 0.91(0.5975–1.3325) | 0.9(0.675–1.345) | 0.412 |
Distribution, no. (%) | 0.85 | |||
< 0.8 (×109/L) | 133(37.9) | 94(38.2) | 39(37.1) | |
≥ 0.8 (×109/L) | 218(62.1) | 152(61.8) | 66(62.9) | |
Hemoglobin (g/L), median (IQR) | 108(98–121) | 107(97.75–120) | 110(100–122) | 0.365 |
Platelet (×109/L), median (IQR) | 130(98–170) | 130(98–169.25) | 130.5(96.25–171.5) | 0.734 |
PT (s), median (IQR) | 10.9(10.5–11.3) | 10.9(10.5–11.3) | 10.8(10.4–11.2) | 0.157 |
APTT (s), median (IQR) | 29.7(26.3–33.6) | 29.85(26.8–33.575) | 29.25(25.425–33.8) | 0.284 |
Fibrinogen (g/L) | 2.664(2.026–3.645) | 2.664(2.026–3.542) | 2.975(2.081–3.959) | 0.192 |
D-Dimer (mg/L), median (IQR) | 0.6(0.51–1.365) | 0.62(0.52–1.518) | 0.57(0.51–1.048) | 0.052 |
TBIL (μmol/L), median (IQR) | 9.19(6.63–13.77) | 9.205(6.635–14.015) | 8.99(6.745–13.385) | 0.869 |
DBIL (μmol/L), median (IQR) | 2.39(1.585–3.57) | 2.41(1.6225–3.5375) | 2.35(1.56–3.845) | 0.866 |
Albumin (g/L), median (IQR) | 37.4(34–40.9) | 37.1(34–40.6) | 38.1(34–41.3) | 0.223 |
Globulin (g/L), median (IQR) | 26.4(23.825–28.8) | 26.4(23.725–28.875) | 26.25(23.925–28.75) | 0.907 |
ALT (U/L), median (IQR) | 21(13.75–34) | 20(14–34.5) | 21(13–33) | 0.69 |
AST (U/L), median (IQR) | 21(16–28) | 21(16–29) | 22(17–28) | 0.786 |
ALT peak (U/L), median (IQR) | 35(24–61) | 35(24–61) | 34(22–61.5) | 0.984 |
AST peak (U/L), median (IQR) | 26(20–39) | 26(20–42) | 25(20–38) | 0.432 |
Creatinine (μmol/L), median (IQR) | 67.35(54.1–79.825) | 67.25(54.65–80.35) | 68.2(53.65–79.5) | 0.57 |
Creatinine peak (μmol/L), median (IQR) | 73.4(58.25–87.925) | 73.1(58.2–87.75) | 74(58.25–88.65) | 0.993 |
LDH (U/L), median (IQR) | 207(164.75–263) | 203(164.25–269.5) | 211.5(166–260.75) | 0.882 |
LDH peak (U/L), median (IQR) | 224.5(175–305.25) | 225(175–311.5) | 220(177.5–292) | 0.762 |
Distribution, no. (%) | 0.92 | |||
< 400 (U/L) | 286(81.5) | 200(81.3) | 86(81.9) | |
≥ 400 (U/L) | 40(11.4) | 29(11.8) | 11(10.5) | |
NA | 25(7.1) | 17(6.9) | 8(7.6) | |
CK (U/L), median (IQR) | 63(41–111.5) | 58.5(40–108.5) | 69.5(43–126.75) | 0.126 |
CK-MB (U/L), median (IQR) | 12.1(9.4–17.7) | 12.1(9.5–17.5) | 12.2(9.33–18.48) | 0.777 |
CRP (mg/L), median (IQR) | 21.2(4.65–51.625) | 20.7(4.35–52.475) | 21.55(6.3–48.475) | 0.764 |
PCT (ng/L), median (IQR) | 0.08(0.05–0.135) | 0.08(0.05–0.1375) | 0.08(0.06–0.135) | 0.665 |
Clinical classification, no. (%) | 0.162 | |||
Mild | 6(1.7) | 2(0.8) | 4(3.8) | |
Moderate | 279(79.5) | 195(79.3) | 84(80) | |
Severe | 33(9.4) | 26(10.6) | 7(6.7) | |
Critical | 33(9.4) | 23(9.3) | 10(9.5) | |
Treatment, no. (%) | ||||
Antiviral treatment | 349(99.4) | 244(99.2) | 105(100) | 1 |
Antibacterial treatment | 328(93.4) | 229(93.1) | 99(94.3) | 0.678 |
Antifungal treatment | 20(5.7) | 13(5.3) | 7(6.7) | 0.33 |
Glucocorticoids | 119(33.9) | 85(34.6) | 34(32.4) | 0.365 |
Intravenous immunoglobulin therapy | 66(18.8) | 46(18.7) | 20(19.0) | 0.39 |
CRRT | 5(1.4) | 3(1.2) | 2(1.9) | 0.024b |
NIVV or high-flow nasal cannula | 37(10.5) | 28(11.4) | 9(8.6) | 0.432 |
Invasive mechanical ventilation | 12(3.4) | 7(2.8) | 5(4.8) | 0.354 |
Aggravation, no. (%) | 0.905 | |||
Mild to Moderate/Severe/Critical | 0(0) | 0(0) | 0(0) | |
Moderate to Severe/Critical | 19(5.4) | 14(5.7) | 5(4.8) | |
Severe to Critical | 31(8.8) | 21(8.5) | 10(9.5) | |
No | 301(85.8) | 211(85.8) | 90(85.7) | |
Death, no. (%) | 14(4.0) | 9(3.7) | 5(4.8) | 0.766 |
Selection of predicting factors associated with deterioration risk
Variables | OR | 95CI% | Estimate | S. E | z value | P value |
---|---|---|---|---|---|---|
Age (years) | 1.339 | 1.191–1.498 | 0.041 | 0.012 | 3.399 | 0.001b |
Sex | ||||||
Male | 1 | – | – | – | – | – |
Female | 0.699 | 0.337–1.448 | −0.358 | 0.372 | −0.964 | 0.335 |
Smoking | 1.598 | 0.668–3.823 | 0.469 | 0.445 | 1.054 | 0.292 |
Hypertension | 3.96 | 1.864–8.415 | 1.376 | 0.385 | 3.579 | 3.452E-04b |
Diabetes mellitus | 5.586 | 2.324–13.426 | 1.720 | 0.447 | 3.845 | 1.207E-04b |
Coronary heart disease | 8.542 | 2.678–27.24 | 2.145 | 0.592 | 3.625 | 2.889E-04b |
Cerebrovascular diseases | 5.29 | 1.347–20.777 | 1.646 | 0.698 | 2.358 | 0.018b |
COPD | 2.497 | 0.465–13.404 | 0.915 | 0.857 | 1.067 | 0.286 |
Cancer | 8.625 | 2.193–33.922 | 2.155 | 0.699 | 3.084 | 0.002b |
Immunodeficiency | 1.00E+ 10 | 0 | 16.392 | 882.743 | 0.019 | 0.985 |
White blood cells | 1.339 | 1.197–1.498 | 0.292 | 0.057 | 5.116 | 3.120E-07b |
Neutrophil | 1.225 | 1.12–1.34 | 0.203 | 0.046 | 4.423 | 9.740E-06b |
Monocyte | 0 | 0–0.027 | −7.771 | 2.122 | −3.662 | 2.507E-04b |
Lymphocyte | ||||||
< 0.8(×109/L) | 1 | – | – | – | – | |
≥ 0.8(×109/L) | 0.012 | 0.002–0.087 | −4.449 | 1.026 | −4.337 | 1.440E-05b |
Hemoglobin (g/L) | 0.942 | 0.92–0.965 | −0.060 | 0.012 | −4.969 | 6.740E-07b |
Platelet (×109/L) | 0.984 | 0.976–0.993 | −0.016 | 0.004 | −3.627 | 2.868E-04b |
PT (s) | 1.785 | 1.335–2.387 | 0.580 | 0.148 | 3.912 | 9.140E-05b |
APTT (s) | 1.05 | 0.994–1.108 | 0.049 | 0.028 | 1.747 | 0.081 |
Fibrinogen (g/L) | 0.542 | 0.363–0.81 | −0.612 | 0.205 | −2.990 | 0.003b |
D-Dimer (mg/L) | 1.114 | 1.059–1.171 | 0.108 | 0.026 | 4.201 | 2.650E-05b |
TBIL (μmol/L) | 1.018 | 0.963–1.075 | 0.017 | 0.028 | 0.624 | 0.533 |
DBIL (μmol/L) | 1.023 | 0.983–1.065 | 0.023 | 0.021 | 1.129 | 0.259 |
Albumin (g/L) | 0.876 | 0.819–0.938 | −0.132 | 0.035 | −3.814 | 1.369E-04b |
Globulin (g/L) | 1.016 | 0.932–1.108 | 0.016 | 0.044 | 0.362 | 0.717 |
ALT (U/L) | 1.011 | 0.997–1.025 | 0.011 | 0.007 | 1.553 | 0.120b |
AST (U/L) | 1.032 | 1.011–1.054 | 0.032 | 0.011 | 2.954 | 0.003b |
ALT peak (U/L) | 1.005 | 1.001–1.009 | 0.005 | 0.002 | 2.400 | 0.016b |
AST peak (U/L) | 1.007 | 1–1.013 | 0.007 | 0.003 | 1.968 | 0.049b |
Creatinine (μmol/L) | 1.007 | 1–1.013 | 0.007 | 0.003 | 2.057 | 0.040b |
Creatinine peak (μmol/L) | 1.01 | 1.003–1.016 | 0.010 | 0.003 | 2.953 | 0.003b |
CK (U/L) | 1.001 | 1–1.003 | 0.001 | 0.001 | 1.445 | 0.148 |
CKMB (U/L) | 1.005 | 0.999–1.012 | 0.005 | 0.003 | 1.621 | 0.105 |
LDH (U/L) | ||||||
< 400 U/L | 1 | – | – | – | – | – |
≥ 400 U/L | 17.472 | 7.053–43.284 | 2.861 | 0.463 | 6.180 | 6.390E-10b |
CRP (mg/L) | 1.029 | 1.02–1.039 | 0.029 | 0.004 | 6.468 | 9.960E-11b |
PCT (ng/L) | 1.107 | 1.031–1.189 | 0.102 | 0.036 | 2.793 | 0.005b |
Intercept and variable | LASSO coefficient | Regression coefficient (β) |
---|---|---|
Intercept | −2.298 | −4.262 |
WBC | 0.025 | 0.059 |
CRP | 0.008 | 0.012 |
Lym ≥ 0.8 × 109/L | 0.977 | 3.056 |
LDH ≥ 400 U/L | −0.759 | −1.3 |