Abstract
The prognostic role and diagnostic ability of coronavirus disease 2019 (COVID-19) disease indicators are not elucidated, thus, the current study aimed to investigate the prognostic role and diagnostic ability of several COVID-19 disease indicators including the levels of oxygen saturation, leukocytes, lymphocytes, albumin, C-reactive protein (CRP), interleukin-6 (IL-6), and D-dimer in patients with COVID-19. The levels of oxygen saturation, lymphocytes, and albumin were significantly higher in the common and severe clinical type patients compared with those in critical type patients. However, levels of leukocytes, CRP, IL-6, and D-dimer were significantly lower in the common and severe type patients compared with those in critical type patients (P < 0.001). Moreover, the current study demonstrated that the seven indicators have good diagnostic and prognostic powers in patients with COVID-19. Furthermore, a two-indicator (CRP and D-dimer) prognostic signature in training and testing datasets was constructed and validated to better understand the prognostic role of the indicators in COVID-19 patients. The patients were classified into high-risk and low-risk groups based on the median-risk scores. The findings of the Kaplan–Meier curve analysis indicated a significant divergence between the high-risk and low-risk groups. The findings of the receiver operating curve (ROC) analysis indicated the good performance of the signature in the prognosis prediction of COVID-19. In addition, a nomogram was constructed to assist clinicians in developing clinical decision-making for COVID-19 patients. In conclusion, the findings of the current study demonstrated that the seven indicators are potential diagnostic markers for COVID-19 and a two-indicator prognostic signature identification may improve clinical management for COVID-19 patients.
Highlights
The coronavirus disease-2019 (COVID-19) outbreak has rapidly spread out globally since the confirmation of the first case in Wuhan city (China) in December 2019 [1]
The receiver operating curve (ROC) analysis revealed that the seven indicators have a good performance in the prognosis of COVID-19 patients (Supplementary Figure 1)
IL-6 had the highest area under the curve (AUC) value (AUC = 0.931), whereas C-reactive protein (CRP) and D2 were ranked second (AUC = 0.918) and third (AUC = 0.884), respectively
Summary
The coronavirus disease-2019 (COVID-19) outbreak has rapidly spread out globally since the confirmation of the first case in Wuhan city (China) in December 2019 [1]. A small number of patients developed severe pneumonia [3,4,5], acute respiratory distress syndrome (ARDS), or Multiple Organ Dysfunction Syndrome, which lead to death. The latest COVID-19 studies focus on patients with severe and critical illnesses. This is because this stage of disease progression may lead to rapid deterioration, which can result in inflammatory storms, respiratory distress, multiple organ failure, and death [9]. Previous studies have reported that high expression levels of IL-6 and interleukin-10 (IL-10) can predict deterioration in patients with COVID-19 [10]. Previous studies have reported that D-dimer elevation, leukopenia, and thrombocytopenia are independent risk factors for severe COVID-19 [11]. A survival analysis was undertaken and a two-indicator prognostic signature was developed to demonstrate the association between indicators and prognosis in COVID-19 patients
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