Does an increase in serum FGF21 level predict 28-day mortality of critical patients with sepsis and ARDS?

Abstract Background Sepsis may be accompanied by acute respiratory distress syndrome (ARDS) in patients admitted to intensive care units (ICUs). It is essential to identify prognostic biomarkers in patients with sepsis and ARDS. Objective Determine whether changes in the level of serum fibroblast growth factor 21 (FGF21) can predict the 28-day mortality of ICU patients with sepsis and ARDS. Methods Consecutive sepsis patients were divided into two groups (Sepsis + ARDS and Sepsis-only), and the Sepsis + ARDS group was further classified as survivors or non-survivors. Demographic data and comorbidities were recorded. The Sequential Organ Failure Assessment (SOFA) score and serum levels of cytokines and other biomarkers were recorded 3 times after admission. Multiple Cox proportional hazards regression was used to identify risk factors associated with 28-day mortality in the Sepsis + ARDS group. Multivariate receiver operating characteristic curve analysis was used to assess the different predictive value of FGF21 and SOFA. Results The Sepsis + ARDS group had a greater baseline SOFA score and serum levels of cytokines and other biomarkers than the Sepsis-only group; the serum level of FGF21 was almost twofold greater in the Sepsis + ARDS group (P < 0.05). Non-survivors in the Sepsis + ARDS group had an almost fourfold greater level of FGF21 than survivors in this group (P < 0.05). The serum level of FGF21 persistently increased from the baseline to the peak of shock and death in the non-survivors, but persistently decreased in survivors (P < 0.05). Changes in the serum FGF21 level between different time points were independent risk factors for mortality. No statistical difference was observed between the AUC of FGF21 and SOFA at baseline. Conclusion A large increase of serum FGF21 level from baseline is associated with 28-day mortality in ICU patients with sepsis and ARDS.

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Does an Increase in Serum FGF21 Level Predict 28-day Mortality of Critical Patients with Sepsis and ARDS?

10.21203/rs.3.rs-349444/v1 ◽

2021 ◽

Author(s):

Xing Li ◽

Hua Shen ◽

Tinghong Zhou ◽

Xiaoyu Cao ◽

Ying Chen ◽

...

Keyword(s):

Risk Factors ◽

Serum Level ◽

Sofa Score ◽

Proportional Hazards ◽

Demographic Data ◽

Serum Levels ◽

Cox Proportional Hazards ◽

Fibroblast Growth Factor 21 ◽

Icu Patients ◽

Fgf21 Level

Abstract BackgroundSepsis may be accompanied by acute respiratory distress syndrome (ARDS) in patients admitted to intensive care units (ICUs). It is essential to identify prognostic biomarkers in patients with sepsis and ARDS.ObjectiveDetermine whether changes in the level of serum fibroblast growth factor 21 (FGF21) can predict the 28-day mortality of ICU patients with sepsis and ARDS.MethodsConsecutive sepsis patients were divided into two groups (Sepsis+ARDS and Sepsis-only), and the Sepsis+ARDS group was further classified as survivors or non-survivors. Demographic data and comorbidities were recorded. The Sequential Organ Failure Assessment (SOFA) score and serum levels of cytokines and other biomarkers were recorded 3 times after admission. Multiple Cox proportional hazards regression was used to identify risk factors associated with 28-day mortality in the Sepsis+ARDS group.ResultsThe Sepsis+ARDS group had a greater baseline SOFA score and serum levels of cytokines and other biomarkers than the Sepsis-only group; the serum level of FGF21 was almost 2-fold greater in the Sepsis+ARDS group (P<0.05). Non-survivors in the Sepsis+ARDS group had an almost 5-fold greater level of FGF21 than survivors in this group (P<0.05). The serum level of FGF21 persistently increased from the baseline to the peak of shock and death in the non-survivors, but persistently decreased in survivors (P<0.05). Changes in the serum FGF21 level between different time points were independent risk factors for mortality.ConclusionA large increase of serum FGF21 level from baseline is associated with 28-day mortality in ICU patients with sepsis and ARDS.

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Risk Factors of Delirium in Sequential Sedation Patients in Intensive Care Units

BioMed Research International ◽

10.1155/2017/3539872 ◽

2017 ◽

Vol 2017 ◽

pp. 1-9 ◽

Cited By ~ 4

Author(s):

Jie Yang ◽

Yongfang Zhou ◽

Yan Kang ◽

Binbin Xu ◽

Peng Wang ◽

...

Keyword(s):

Risk Factors ◽

Intensive Care ◽

Sofa Score ◽

Maintenance Dose ◽

Proportional Hazards ◽

Confusion Assessment Method ◽

Assessment Method ◽

Cox Proportional Hazards ◽

Older Age ◽

Independent Risk Factors

Background. Delirium is a primary adverse event in ventilated patients who receive long-term monosedative treatment. Sequential sedation may reduce these adverse effects. This study evaluated risk factors for delirium in sequential sedation patients. Methods. A total of 141 patients who underwent sequential sedation were enrolled. Delirium was diagnosed using Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) scale. Univariate and multivariate Cox proportional hazards regressions were used to predict risk factors. Results. Older age (≥51) (RR = 2.432, 95% CL 1.316–4.494, p=0.005), higher SOFA score (≥14) (RR = 2.022, 95% CL 1.076–3.798, p=0.029), regular smoking (RR = 2.366, 95% CL 1.277–4.382, p=0.006), and higher maintenance dose of midazolam (RR = 1.052, 95% CL 1.000–1.107, p=0.049) and fentanyl (RR = 1.045, 95% CL 1.019–1.072, p=0.001) when patients met sequential criteria, were independent risk factors of delirium. Sequential sedation with dexmedetomidine (RR = 0.448, 95% CL 0.209–0.963, p=0.040) was associated with a lower risk of delirium. Conclusions. Older age, higher SOFA score, regular smoking, and higher maintenance dose of midazolam and fentanyl when patients met sequential criteria were independent risk factors of delirium in sequential sedation patients. Sequential sedation with dexmedetomidine reduced risk of delirium.

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Risk factor analysis and nomogram for predicting in-hospital mortality in ICU patients with sepsis and lung infection

BMC Pulmonary Medicine ◽

10.1186/s12890-021-01809-8 ◽

2022 ◽

Vol 22 (1) ◽

Author(s):

Yinlong Ren ◽

Luming Zhang ◽

Fengshuo Xu ◽

Didi Han ◽

Shuai Zheng ◽

...

Keyword(s):

Hospital Mortality ◽

Prediction Model ◽

Sofa Score ◽

Medical Information ◽

Troponin T ◽

Characteristic Curve ◽

Oxygenation Index ◽

Lung Infection ◽

Calibration Plot ◽

Icu Patients

Abstract Background Lung infection is a common cause of sepsis, and patients with sepsis and lung infection are more ill and have a higher mortality rate than sepsis patients without lung infection. We constructed a nomogram prediction model to accurately evaluate the prognosis of and provide treatment advice for patients with sepsis and lung infection. Methods Data were retrospectively extracted from the Medical Information Mart for Intensive Care (MIMIC-III) open-source clinical database. The definition of Sepsis 3.0 [10] was used, which includes patients with life-threatening organ dysfunction caused by an uncontrolled host response to infection, and SOFA score ≥ 2. The nomogram prediction model was constructed from the training set using logistic regression analysis, and was then internally validated and underwent sensitivity analysis. Results The risk factors of age, lactate, temperature, oxygenation index, BUN, lactate, Glasgow Coma Score (GCS), liver disease, cancer, organ transplantation, Troponin T(TnT), neutrophil-to-lymphocyte ratio (NLR), and CRRT, MV, and vasopressor use were included in the nomogram. We compared our nomogram with the Sequential Organ Failure Assessment (SOFA) score and Simplified Acute Physiology Score II (SAPSII), the nomogram had better discrimination ability, with areas under the receiver operating characteristic curve (AUROC) of 0.743 (95% C.I.: 0.713–0.773) and 0.746 (95% C.I.: 0.699–0.790) in the training and validation sets, respectively. The calibration plot indicated that the nomogram was adequate for predicting the in-hospital mortality risk in both sets. The decision-curve analysis (DCA) of the nomogram revealed that it provided net benefits for clinical use over using the SOFA score and SAPSII in both sets. Conclusion Our new nomogram is a convenient tool for accurate predictions of in-hospital mortality among ICU patients with sepsis and lung infection. Treatment strategies that improve the factors considered relevant in the model could increase in-hospital survival for these ICU patients.

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SO044ALPHA LIPOIC ACID COMPARED TO SELENIUM IN MITOCHONDRIAL RESUSCITATION AND MI RNA-126 EXPRESSION IN HEMODIALYSIS PATIENTS

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfaa139.so044 ◽

2020 ◽

Vol 35 (Supplement_3) ◽

Author(s):

Magdy ElSharkawy ◽

Zainab Al Kasaby ◽

Hosny A. Elewa ◽

Maha Abdelrahman

Keyword(s):

Oxidative Stress ◽

Serum Level ◽

Lipoic Acid ◽

Demographic Data ◽

Serum Levels ◽

Cardiovascular Complications ◽

Base Line ◽

Coq10 Level ◽

Mitochondrial Functions ◽

Significant Difference

Abstract Background and Aims anti-oxidants may decrease the risk of cardiovascular complications (CVC) in HD patients. We aimed to study antioxidant effect of Alpha lipoic acid and selenium on oxidative stress, endothelial repair, and mitochondrial functions in HD patients by evaluating the serum level of reactive oxygen species (ROS), miRNA-126, and CoQ10. Method 60 individuals were enrolled and randomized into 3 groups, G1; 22 HD patients as control, G2; 20 HD patients received Selenium, and G3;18 HD patients received. Serum levels of ROS, CoQ10, and miRNA-126 were assessed at base line and after three months treatment for all patients. Results At baseline, all groups were matched regarding their demographic data and target parameters. After three months, in G1; the serum level of ROS increased significantly (P < 0.05), CoQ10 didn't change significantly (P > 0.05), while the fold expression of miRNA-126 decreased significantly (P < 0.05). In G2,3; there were statistical significant changes in target parameters after the treatment, ROS level decreased significantly by 34%, and by 79%, CoQ10 mean levels increased significantly from 13.21 to 28.35, and from 13.46 to 36.43 ng/ml, mean fold expression of miRNA126, increased significantly by 6.94, and 10.54 folds, in Selenium and, Thiotacid groups respectively. The results showed that Thiotacid was better than Selenium in ROS level reduction, and CoQ10 level improvement, while no statistical significant difference between two drugs regarding miRNA126 level (P > 0.05). Conclusion Selenium and, Thiotacid reduce oxidative stress and also they enhancing the endothelial repairing, and improve mitochondrial functions and thus may reduce risk of CVC.

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P–389 The relationship between serum hormone profiles and missed abortion in humans

Human Reproduction ◽

10.1093/humrep/deab130.388 ◽

2021 ◽

Vol 36 (Supplement_1) ◽

Author(s):

Y Yang ◽

J Wu ◽

X Wang ◽

J Yao ◽

K S Lao ◽

...

Keyword(s):

Chinese Population ◽

Serum Levels ◽

Assay Method ◽

Fibroblast Growth Factor 21 ◽

Enzyme Linked Immunosorbent Assay ◽

Missed Abortion ◽

Fatty Acid Binding ◽

Obesity And Diabetes ◽

Fgf21 Level ◽

The Relationship

Abstract Study question Are circulating profiles of metabolic-related hormones also associated with the missed abortion (MA) in humans? Summary answer Serum levels of fatty acid-binding protein–4 (FABP4) and fibroblast growth factor 21 (FGF21) are positively associated with MA. What is known already A cluster of endocrine hormones, including FABP4, FGF21, adiponectin, lipocalin–2 (LCN2), exhibit pleiotropic effects on regulating systematic metabolism. Serum levels of them are associated with gestational obesity and diabetes and affect pregnancy outcomes, however, the relationship between their circulating profiles and MA is under-investigated. Study design, size, duration 78 patients with MA and 86 healthy pregnant subjects matching on maternal age and body mass index (BMI) were nested from a prospective cohort in the Chinese population. Participants/materials, setting, methods Fasting serum samples from all participants were collected to test their serum levels of FGF21, FABP4, adiponectin, and LCN2 by enzyme-linked immunosorbent assay method (ELISA). Main results and the role of chance There were no significant differences in circulating profiles of adiponectin and LCN2 between MA patients and healthy pregnant subjects. By contrast, circulating levels of FGF21 and FABP4 were significantly and independently elevated in patients with MA relative to control cases even after adjusting confounding factors (for FGF21: MA: 28.96 ± 2.17 ng/ml; HP: 19.18 ± 1.12 ng/ml, P < 0.001, for FABP4: MA: 152.50 ± 9.31 pg/ml; HP: 90.86 ± 4.14 pg/ml, P < 0.001). Linear regression analysis showed, FGF21 raised every 10 pg/ml contributed to a 24% (95% CI: 15% - 34%) increase in the risk of MA, whereas the OR of FABP4 for the risk of MA was 1.052 (95% CI: 1.022 –1.088). Furthermore, using serum FGF21 level or FABP4 levels discriminated MA from healthy controls with an area under the operating characteristic’s curve (AUROC) of 0.81 (95% CI 0.76–0.92) and 0.70 (95% CI 0.62 - 0.78), respectively. Limitations, reasons for caution The study is limited by the sample size. In addition, our results were based-on Chinese population, whether it could be observed in other ethics group remain to be investigated. Meanwhile, the cause-effect relationship between increased serum FGF21 level and MA remains to be explored. Wider implications of the findings: Our data would suggest that serum levels of FGF21 and FABP4 are associated with MA. Moreover, circulating FGF21 levels may serve as a potential diagnostic biomarker for the recognition of M. Trial registration number IRB Ref. No.: KY201913

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Development and validation of a nomogram for predicting the probability of nontraumatic osteonecrosis of the femoral head

10.21203/rs.2.23333/v1 ◽

2020 ◽

Author(s):

Qiang Xu ◽

Hangjun Chen ◽

Sihai Chen ◽

Jing Shan ◽

Guoming Xia ◽

...

Keyword(s):

Risk Factors ◽

Femoral Head ◽

Demographic Data ◽

Characteristic Curve ◽

Model Development ◽

Lasso Regression ◽

Early Screening ◽

Good Discrimination ◽

Internal Validation ◽

Selection Operator

Abstract Background Although corticosteroids and alcohol are two major risk factors for nontraumatic osteonecrosis of the femoral head (NONFH), the effects of other factors have rarely been studied, thereby making early diagnosis and treatment of NONFH difficult. This study aimed to develop and validate a nomogram to estimate the probability of NONFH using clinical risk factors other than corticosteroids and alcohol consumption. Methods A training cohort of 790 patients (n=434, NONFH; n=356, femoral neck fractures [non-NONFH]) diagnosed in our hospital from January 2011 to December 2016 was used for model development. A least absolute shrinkage and selection operator (lasso) regression model was used for date dimension reduction and optimal predictor selection. A predictive model was developed from univariate and multivariate logistic regression analyses. Performance characterisation of the resulting nomogram included calibration, discriminatory ability, and clinical usefulness. After internal validation, the nomogram was further evaluated in a separate cohort of 300 consecutive patients included between January 2017 and December 2018. Results The simple prediction nomogram included five predictors from univariate and multivariate analyses, including gender, total cholesterol levels, triglyceride levels, white blood cell count, and platelet count. Internal validation showed that the model had good discrimination (area under the receiver operating characteristic curve [AUC]=0.80) and calibration. Good discrimination (AUC=0.81) and calibration were preserved in the validation cohort. Decision curve analysis showed that the predictive nomogram was clinically useful. Conclusions The simple diagnostic nomogram, which combines demographic data and laboratory blood test results, was able to quantify the probability of NONFH in cases of early screening and diagnosis.

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Circulating miRNA-29b and Sclerostin Levels Correlate with Coronary Artery Calcification and Cardiovascular Events in Maintenance Hemodialysis Patients

Cardiology Research and Practice ◽

10.1155/2021/9208634 ◽

2021 ◽

Vol 2021 ◽

pp. 1-10

Author(s):

Jiqing He ◽

Mingjiao Pan ◽

Mingzhi Xu ◽

Ruman Chen

Keyword(s):

Risk Factors ◽

Coronary Artery ◽

Serum Level ◽

Coronary Artery Calcification ◽

Cardiovascular Events ◽

Serum Levels ◽

Maintenance Hemodialysis ◽

Circulating Mirna ◽

Independent Risk Factors ◽

Hs Crp

Objective. Coronary artery calcification (CAC) is a common complication in end-stage renal disease (ESRD) patients undergoing maintenance hemodialysis (MHD), and the extent of CAC is a predominant predictor of cardiovascular outcomes in MHD patients. In this study, we sought to uncover the relationship between circulating miRNA-29b, sclerostin levels, CAC, and cardiovascular events (CVEs) in MHD patients. Methods. This study recruited patients receiving MHD for at least three months in the Hainan General Hospital between January 2016 and June 2019, and all patients were followed up 24 months for CVEs. The serum level of sclerostin was determined by enzyme-linked immunosorbent assay (ELISA) and miRNA-29b expression by real-time qPCR (RT-qPCR). All patients received cardiac CT scans to evaluate CAC, and CAC scores were expressed in Agatston units. The MHD patients with CACs <100 were arranged into the CAC (<100) group, those with 100–400 CACs into the CAC (100–400) group, and those with CACs >400 into the CAC (>400) group. Net reclassification index (NRI) and integrated discrimination index (IDI) were calculated to assess the predictive performance of serum sclerostin level for the occurrence of CVEs. Results. Compared with the CAC (<100) group, the CAC (>400) group had higher proportions of older patients, hypertension and diabetes mellitus patients, longer dialysis duration, higher mean arterial pressure (MAP), higher levels of high-sensitivity C-reactive protein (hs-CRP), alkaline phosphatase (ALP), and phosphate ( P < 0.05 ). It was found that the CAC (100–400) and CAC (>400) groups exhibited higher serum levels of sclerostin but lower levels of miRNA-29b than the CAC (<100) group ( P < 0.05 ) and the CAC (>400) group had a higher level of sclerostin and a lower level of miRNA-29b than the CAC (100–400) group ( P < 0.05 ). The circulating level of miRNA-29b was negatively correlated with the serum level of sclerostin in MHD patients (r = −0.329, P < 0.01 ). The multivariate logistic regression analysis showed that hs-CRP, phosphate, sclerostin, and miRNA-29b were independent risk factors for CAC in MHD patients ( P < 0.05 , Table 2). ROC for prediction of CAC by sclerostin yielded 0.773 AUC with 95% CI 0.683–0.864 ( P < 0.01 ). As depicted by Kaplan–Meier curves of CVE incidence in MHD patients according to median sclerostin (491.88 pg/mL) and median miRNA-29b (Ct = 25.15), we found that serum levels of sclerostin and miRNA-29b were correlated with the incidence of CVEs in MHD patients. When a new model was used to predict the incidence of CVEs, NRI 95% CI was 0.60 (0.16–1.03) ( P < 0.05 ) and IDI 95% CI was 0.002 (−0.014 to 0.025) ( P < 0.05 ), suggesting that sclerostin added into the old model could improve the prediction of the incidence of CVEs. Conclusions. These data suggest that circulating miRNA-29b and sclerostin levels are correlated with CAC and incidence of CVEs in MHD patients. Higher sclerostin and lower miRNA-29b may serve as independent risk factors for the incidence of CVEs in MHD patients.

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Prognostic Nomogram for Penile Cancer, an Analysis Based on SEER Database

10.21203/rs.3.rs-50766/v1 ◽

2020 ◽

Author(s):

Yong-Bo Chen ◽

Liang Gao ◽

Liang-You Tang ◽

Jiang Guo ◽

Yu-Chang Tian ◽

...

Keyword(s):

Risk Factors ◽

Penile Cancer ◽

Proportional Hazards ◽

Characteristic Curve ◽

Cox Proportional Hazards ◽

Seer Database ◽

Survival Status ◽

Cox Proportional Hazards Regression ◽

Proportional Hazards Regression ◽

Development Group

Abstract Background: We aimed to establish a prognostic nomogram for Penile Cancer (PC) patients based on the Surveillance, Epidemiology, and End Results Program (SEER) database.Methods: Data of 1694 patients between 2010 and 2015 were downloaded and extracted from the SEER database. Then, they were randomly divided into the development group (70%) and the verification group (30%). Following, the univariate and multivariate Cox proportional hazards regression was respectively used to explore the possible risk factors of PC. Factors which significantly related to the overall survival (OS) were used to establish the nomogram. Further, the concordance index (C-index), receiver operating characteristic curve (ROC) and calibration curve were used to assess the nomogram, respectively. An internal validation was carried out to test the accuracy and effectiveness of nomogram. Finally, the Kaplan-Meier calculation was used to predict the further survival status of these patients.Results: Multivariate Cox proportional hazards regression demonstrated that the independent prognostic risk factors associated with PC were age, stage T, N and M, and grade, with a moderate c-index of 0.732 [95% confidence interval (CI), 0.706-0.757] in development group and 0.743 (95% CI, 0.703-0.782) in verification group. Meanwhile, the areas under the ROC (AUC) of 3-year and 5-year survival were 0.739 and 0.727, respectively. The survival calibration curves of 3-year and 5-year brought out a high consistency. Conclusion: Our study obtained a satisfactory nomogram to reveal the survival of PC patients, which could be helpful for clinicians to assess the situation of PC patients and to implement the further treatment.

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Targeted metabolomic profiling and prediction of cardiovascular events: a prospective study of patients with psoriatic arthritis and psoriasis

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2021-220168 ◽

2021 ◽

pp. annrheumdis-2021-220168

Author(s):

Keith Colaco ◽

Ker-Ai Lee ◽

Shadi Akhtari ◽

Raz Winer ◽

Paul Welsh ◽

...

Keyword(s):

Risk Factors ◽

Regression Models ◽

Proportional Hazards ◽

Cox Regression ◽

Characteristic Curve ◽

Density Lipoprotein ◽

Receiver Operator Characteristic Curve ◽

Cox Proportional Hazards ◽

A Prospective Study ◽

Age And Sex

ObjectiveIn patients with psoriatic disease (PsD), we sought serum metabolites associated with cardiovascular (CV) events and investigated whether they could improve CV risk prediction beyond traditional risk factors and the Framingham Risk Score (FRS).MethodsNuclear magnetic resonance metabolomics identified biomarkers for incident CV events in patients with PsD. The association of each metabolite with incident CV events was analysed using Cox proportional hazards regression models first adjusted for age and sex, and subsequently for traditional CV risk factors. Variable selection was performed using penalisation with boosting after adjusting for age and sex, and the FRS.ResultsAmong 977 patients with PsD, 70 patients had incident CV events. In Cox regression models adjusted for CV risk factors, alanine, tyrosine, degree of unsaturation of fatty acids and high-density lipoprotein particles were associated with decreased CV risk. Glycoprotein acetyls, apolipoprotein B and cholesterol remnants were associated with increased CV risk. The age-adjusted and sex-adjusted expanded model with 13 metabolites significantly improved prediction of CV events beyond the model with age and sex alone, with an area under the receiver operator characteristic curve (AUC) of 79.9 versus 72.6, respectively (p=0.02). Compared with the FRS alone (AUC=73.9), the FRS-adjusted expanded model with 11 metabolites (AUC=75.0, p=0.72) did not improve CV risk discrimination.ConclusionsWe identify novel metabolites associated with the development of CV events in patients with PsD. Further study of their underlying causal role may clarify important pathways leading to CV events in this population.

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A New Predictor of Disease Severity in Patients with COVID-19 in Wuhan, China

10.1101/2020.03.24.20042119 ◽

2020 ◽

Cited By ~ 4

Author(s):

Ying Zhou ◽

Zhen Yang ◽

Yanan Guo ◽

Shuang Geng ◽

Shan Gao ◽

...

Keyword(s):

Risk Factors ◽

Disease Severity ◽

Predictive Value ◽

Demographic Data ◽

Characteristic Curve ◽

Severe Pneumonia ◽

Internal Validation ◽

Predictive Values ◽

Radiological Data ◽

D Dimer

AbstractBackgroundSevere acute respiratory syndrome coronavirus 2 (SARS-CoV-2) broke out in Wuhan, Hubei, China. This study sought to elucidate a novel predictor of disease severity in patients with coronavirus disease-19 (COVID-19) cased by SARS-CoV-2.MethodsPatients enrolled in this study were all hospitalized with COVID-19 in the Central Hospital of Wuhan, China. Clinical features, chronic comorbidities, demographic data, and laboratory and radiological data were reviewed. The outcomes of patients with severe pneumonia and those with non-severe pneumonia were compared using the Statistical Package for the Social Sciences (IBM Corp., Armonk, NY, USA) to explore clinical characteristics and risk factors. The receiver operating characteristic curve was used to screen optimal predictors from the risk factors and the predictive power was verified by internal validation.ResultsA total of 377 patients diagnosed with COVID-19 were enrolled in this study, including 117 with severe pneumonia and 260 with non-severe pneumonia. The independent risk factors for severe pneumonia were age [odds ratio (OR): 1.059, 95% confidence interval (CI): 1.036–1.082; p < 0.001], N/L (OR: 1.322, 95% CI: 1.180–1.481; p < 0.001), CRP (OR: 1.231, 95% CI: 1.129–1.341; p = 0.002), and D-dimer (OR: 1.059, 95% CI: 1.013–1.107; p = 0.011). We identified a product of N/L*CRP*D-dimer as having an important predictive value for the severity of COVID-19. The cutoff value was 5.32. The negative predictive value of less than 5.32 for the N/L*CRP*D-dimer was 93.75%, while the positive predictive value was 46.03% in the test sets. The sensitivity and specificity were 89.47% and 67.42%. In the training sets, the negative and positive predictive values were 93.80% and 41.32%, respectively, with a specificity of 70.76% and a sensitivity of 89.87%.ConclusionsA product of N/L*CRP*D-dimer may be an important predictor of disease severity in patients with COVID-19.

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