Nomogram for prediction of fatal outcome in patients with severe COVID-19: a multicenter study

Yun Yang; Xiao-Fei Zhu; Jian Huang; Cui Chen; Yang Zheng; Wei He; Ling-Hao Zhao; Qian Gao; Xuan-Xuan Huang; Li-Juan Fu; Yu Zhang; Yan-Qin Chang; Huo-Jun Zhang; Zhi-Jie Lu

doi:10.1186/s40779-021-00315-6

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Nomogram for prediction of fatal outcome in patients with severe COVID-19: a multicenter study

RESEARCH | Updated：2023-02-28

- Nomogram for prediction of fatal outcome in patients with severe COVID-19: a multicenter study
- Nomogram for prediction of fatal outcome in patients with severe COVID-19: a multicenter study
- 解放军医学杂志（英文版） 2021年8卷第4期页码：535-545
- Affiliations：
  
  1.The Third Affiliated Hospital of Second Military Medical University, Shanghai 200438, China
  2.The Guanggu Branch of the Women and Children’s Hospital of Hubei Province, Wuhan 430070, China
  3.The First Affiliated Hospital of Second Military Medical University, Shanghai 200438, China
  4.904 Hospital of PLA Joint Logistic Support Force, Wuxi 215000, Jiangsu, China
  5.Tongji Taikang Hospital, Wuhan 430050, China
  6.924 Hospital of PLA Joint Logistic Support Force, Guilin 541002, Guangxi, China
  7.Huoshen Mountain Hospital, Wuhan 430113, China
- Author bio：
  
  * changyanqin1018@163.com;
  chyyzhj@163.com;
  luzhijieehbh@126.com
- Funds：
  
  grants from the National Natural Science Foundation of China(81502416)
- DOI：10.1186/s40779-021-00315-6
  中图分类号：
- 纸质出版：2021-12
- Accepted：
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Nomogram for prediction of fatal outcome in patients with severe COVID-19: a multicenter study[J]. 解放军医学杂志（英文版）, 2021,8(4):535-545.

Yang et al.: Nomogram for prediction of fatal outcome in patients with severe COVID-19: a multicenter study. Mil Med Res, 2021, 8: 21.
Nomogram for prediction of fatal outcome in patients with severe COVID-19: a multicenter study[J]. 解放军医学杂志（英文版）, 2021,8(4):535-545. DOI： 10.1186/s40779-021-00315-6.

Yang et al.: Nomogram for prediction of fatal outcome in patients with severe COVID-19: a multicenter study. Mil Med Res, 2021, 8: 21. DOI： 10.1186/s40779-021-00315-6.

摘要

Abstract

Background:

To develop an effective model of predicting fatal outcomes in the severe coronavirus disease 2019 (COVID-19) patients.

Methods:

Between February 20

2020 and April 4

2020

consecutive confirmed 2541 COVID-19 patients from three designated hospitals were enrolled in this study. All patients received chest computed tomography (CT) and serological examinations at admission. Laboratory tests included routine blood tests

liver function

renal function

coagulation profile

C-reactive protein (CRP)

procalcitonin (PCT)

interleukin-6 (IL-6)

and arterial blood gas. The SaO

was measured using pulse oxygen saturation in room air at resting status. Independent high-risk factors associated with death were analyzed using Cox proportional hazard model. A prognostic nomogram was constructed to predict the survival of severe COVID-19 patients.

Results:

There were 124 severe patients in the training cohort

and there were 71 and 76 severe patients in the two independent validation cohorts

respectively. Multivariate Cox analysis indicated that age ≥70 years (

=1.184

95%CI 1.061–1.321)

panting (breathing rate ≥30/min) (

=3.300

95%CI 2.509–6.286)

lymphocyte count

1.0×10

/L (

=2.283

95%CI 1.779–3.267)

and interleukin-6 (IL-6)

10 pg/ml (

=3.029

95%CI 1.567–7.116) were independent high-risk factors associated with fatal outcome. We developed the nomogram for identifying survival of severe COVID-19 patients in the training cohort (AUC=0.900

95%CI 0.841–0.960

sensitivity 95.5%

specificity 77.5%); in validation cohort 1 (AUC=0.811

95%CI 0.763–0.961

sensitivity 77.3%

specificity 73.5%); in validation cohort 2 (AUC=0.862

95%CI 0.698–0.924

sensitivity 92.9%

specificity 64.5%). The calibration curve for probability of death indicated a good consistence between prediction by the nomogram and the actual observation. The prognosis of severe COVID-19 patients with high levels of IL-6 receiving tocilizumab were better than that of those patients without tocilizumab both in the training and validation cohorts

but without difference (

=0.105 for training cohort

=0.133 for validation cohort 1

and

=0.210 for validation cohort 2).

Conclusions:

This nomogram could help clinicians to identify severe patients who have high risk of death

and to develop more appropriate treatment strategies to reduce the mortality of severe patients. Tocilizumab may improve the prognosis of severe COVID-19 patients with high levels of IL-6.

关键词

Keywords

references

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