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Development of a laboratory-based nomogram for predicting clinical outcomes in patients with severe COVID-19

Langqing Xu1, Chunyang Hou2, Jing Jie1

  • 1Department of Respiratory Medicine, Center for Infectious Diseases and Pathogen Biology, State Key Laboratory for Diagnosis and Treatment of Severe Zoonotic Infectious Diseases, The First Hospital of Jilin University, Changchun, China.

Frontiers in Medicine
|December 22, 2025
PubMed

Insights

High ferritin and IL-10 levels predict poor response to glucocorticoids in severe COVID-19 patients. A new nomogram integrating these biomarkers aids risk stratification for personalized treatment strategies.

Area of Science:

  • Critical Care Medicine
  • Immunology
  • Infectious Diseases

Background:

  • Glucocorticoids are standard for severe COVID-19, but outcomes vary significantly.
  • Inflammatory markers may help predict treatment response and personalize care.

Purpose of the Study:

  • To develop a predictive model for glucocorticoid treatment response in severe COVID-19.
  • To integrate inflammatory biomarkers for improved risk stratification.

Main Methods:

  • Retrospective analysis of 151 severe COVID-19 patients receiving glucocorticoids.
  • LASSO and logistic regression identified predictors; ROC curves determined thresholds.
  • A nomogram was built and validated using split-sample and cross-validation.

Main Results:

  • Elevated ferritin (>970.7 ng/mL) and IL-10 (>4.79 pg/mL) predicted glucocorticoid resistance (AUC 0.779-0.780).
  • The nomogram included diabetes, ferritin, and IL-10, showing good calibration and discrimination.
  • Diabetes was associated with worse outcomes, potentially worsened by glucocorticoid-induced hyperglycemia.

Conclusions:

  • A novel nomogram incorporating ferritin and IL-10 demonstrates predictive value for glucocorticoid response in severe COVID-19.
  • This tool may facilitate risk stratification and personalized management.
  • Prospective validation in larger cohorts is recommended.
Abstract

Keywords:
Interleukin-10cytokine stormferritinglucocorticoid therapynomogram modelpredictive biomarkerssevere COVID-19

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