Cancer distribution in 103 COVID-19 patients
A total of 103 (3.5%) cancer cases in 2980 patients with COVID-19 were enrolled in this study. The cancer categories of the 103 patients included breast cancer (22.3%), lung cancer (16.5%), bladder cancer (8.7%), esophageal cancer (7.8%), gastric cancer (6.8%), thyroid cancer (5.8%), rectal cancer (4.9%), colon cancer (3.9%), larynx cancer (3.9%), cervical cancer (3.9%), prostate cancer (3.9%), liver cancer (2.9%), nasopharyngeal cancer (2.9%), endometrial cancer (2.9%), renal cancer (1%), ovarian cancer (1%) and testicular cancer (1%) (Table 1).
Table 1
The categories of the 103 COVID-19 patients with cancer
Tumor types | Number of patients (%) |
Breast cancer | 23 (22.3%) |
Lung cancer | 17 (16.5%) |
Bladder cancer | 9 (8.7%) |
Esophagus cancer | 8 (7.8%) |
Gastric cancer | 7 (6.8%) |
Thyroid cancer | 6 (5.8%) |
Rectal cancer | 5 (4.9%) |
Cervical cancer | 4 (3.9%) |
Larynx Cancer | 4 (3.9%) |
Colon cancer | 4 (3.9%) |
Prostate cancer | 4 (3.9%) |
Nasopharyngeal cancer | 3 (2.9%) |
Liver cancer | 3 (2.9%) |
Endometrial cancer | 3 (2.9%) |
Testicular cancer | 1 (1%) |
Ovarian cancer | 1 (1%) |
Renal cancer | 1 (1%) |
Comparison Between Severe And Non-severe Patients
The patients consisted of 47 females (45.6%) and 56 males (54.4%), and 36 (35%) in severe group and 67 (65%) in non-severe group. The median age of cancer patients was 66 (ranging from 24 to 90), and the age in the severe group was older than that in non-severe group. The smoking people accounted for a higher proportion in the severe group than in the non-severe group (Table 2).
Table 2
Clinical features and laboratory findings differences between severe and non-severe patients
Clinical features | All (n = 103) | Non-severe (n = 67) | Severe (n = 36) | P-value |
Age | 66.0(24.0–90.0) | 65.0(43.0–90.0) | 70.0(24.0–87.0) | 0.004 |
Sex | | | | 0.097 |
Female | 47 (45.6%) | 35 (52.2%) | 12 (33.3%) | |
Male | 56 (54.4%) | 32 (47.8%) | 24 (66.7%) | |
Smoking | 20 (19.4%) | 8 (11.9%) | 12 (33.3%) | 0.017 |
Comorbidities | | | | |
Diabetes | 14 (13.6%) | 5 (7.5%) | 9 (25%) | 0.018 |
Hypertension | 37 (35.9%) | 22 (32.8%) | 15 (41.7%) | 0.396 |
Heart disease | 11 (10.7%) | 4 (6.0%) | 7 (19.4%) | 0.047 |
Symptoms | | | | |
Fever | 73 (70.9%) | 45 (67.2%) | 28 (77.8%) | 0.363 |
Cough | 70 (68.0%) | 49 (73.1%) | 21 (58.3%) | 0.183 |
Dyspnea | 24 (23.3%) | 9 (13.4%) | 15 (41.7%) | 0.003 |
Vomiting | 5 (4.9%) | 2 (3.0%) | 3 (8.3%) | 0.340 |
Diarrhea | 7 (6.8%) | 3 (4.5%) | 4 (11.1%) | 0.235 |
Laboratory findings | | | | |
WBC (×109/L) | 5.29 (1.90–25.10); n = 100 | 4.77 (1.90–25.10); n = 65 | 7.16 (2.00-18.80); n = 35 | < 0.001 |
Neutrophil (×109/L) | 3.49 (0.67–22.40); n = 100 | 3.00 (0.67–22.40); n = 65 | 5.27 (1.03–17.36); n = 35 | < 0.001 |
Lymphocyte (×109/L) | 1.06 (0.22–2.89); n = 100 | 1.23 (0.33–2.62); n = 65 | 0.80 (0.22–2.89); n = 35 | 0.003 |
NLR | 2.93 (0.64–32.23); n = 100 | 2.29 (0.64–18.39); n = 65 | 6.93 (1.20-32.23); n = 35 | < 0.001 |
Monocytes (×109/L) | 0.43 (0.11–9.90); n = 72 | 0.41 (0.11–9.90); n = 52 | 0.50 (0.14–1.04); n = 20 | 0.297 |
Eosnophils (×109/L) | 0.07 (0.00-0.90); n = 72 | 0.08 (0.00-0.51); n = 52 | 0.03 (0.00-0.90); n = 20 | 0.007 |
Basophils (×109/L) | 0.02 (0.00-0.11); n = 72 | 0.02 (0.00-0.11); n = 52 | 0.02 (0.00-0.05); n = 20 | 0.09 |
RBC (×1012/L) | 3.95 (2.03–5.77); n = 73 | 4.01 (2.03–5.14); n = 52 | 3.53 (2.63–5.77); n = 21 | 0.116 |
HB (g/L) | 116.00 (68.00-154.00); n = 73 | 119.00 (68.00-154.00); n = 52 | 102.00 (79.00-154.00); n = 21 | 0.065 |
PLT (×109/L) | 203.00 (53.00-431.00); n = 72 | 205.00 (67.00-431.00); n = 52 | 190.00 (53.00-312.00); n = 20 | 0.606 |
CRP (mg/L) | 2.52 (0.14-280.32); n = 90 | 1.39 (0.14-137.52); n = 58 | 42.59 (0.05-280.32); n = 32 | < 0.001 |
ALT (U/L) | 19.17 (4.50-131.20); n = 97 | 19.05 (4.50-131.20); n = 64 | 20.70 (6.00-100.30); n = 33 | 0.87 |
AST (U/L) | 21.70 (10.00-147.20); n = 84 | 20.45 (10.00-147.20); n = 52 | 26.70 (12.00-92.60); n = 32 | 0.014 |
Total protein (g/L) | 64.99 (53.70-87.58); n = 71 | 65.50 (55.45–87.58); n = 51 | 60.89 (53.70-78.97); n = 20 | 0.04 |
Albumin (g/L) | 37.29 (23.60–48.00); n = 71 | 38.14 (23.60–48.00); n = 51 | 32.61 (25.30–43.50); n = 20 | 0.002 |
Globulin (g/L) | 28.00 (17.31–46.24); n = 71 | 27.30 (17.31–40.49); n = 51 | 28.20 (24.00-46.24); n = 20 | 0.818 |
A/G | 1.30 (0.39–2.20); n = 71 | 1.35 (0.39–2.20); n = 51 | 1.22 (0.71–1.46); n = 20 | 0.017 |
Total bilirubin (umol/L) | 10.32 (4.20-44.58); n = 70 | 10.23 (4.20-33.46); n = 51 | 11.70 (6.00-44.58); n = 19 | 0.152 |
Direct Bilirubin (umol/L) | 2.71 (0.00-23.90); n = 70 | 2.50 (0.00-14.20); n = 51 | 3.86 (0.00-23.90); n = 19 | 0.053 |
Indirect bilirubin (umol/L) | 7.39 (2.99–26.42); n = 70 | 7.32 (3.00-26.42); n = 51 | 7.90 (2.99–22.68); n = 19 | 0.468 |
BUN (umol/L) | 4.67 (2.68–29.61); n = 68 | 4.62 (2.68–29.61); n = 49 | 5.47 (2.93–18.77); n = 19 | 0.114 |
Creatinine (umol/L) | 57.72 (13.25-345.35); n = 70 | 58.17 (31.60-345.35); n = 50 | 55.15 (13.25-145.39); n = 20 | 0.559 |
Uric acid (umol/L) | 268.01 (100.00-275.95)); n = 69 | 304.73 (151.56-575.95); n = 50 | 163.00 (100.00-547.00); n = 19 | < 0.001 |
ALP (U/L) | 71.10 (42.59–493.30); n = 70 | 67.80 (42.59–493.30); n = 51 | 74.60 (55.16–238.00); n = 19 | 0.212 |
γ-GT (U/L) | 26.47 (8.15–263.60); n = 70 | 26.30 (8.15–263.60); n = 51 | 33.62 (11.02–239.60); n = 19 | 0.262 |
CK (U/L) | 48.40 (10.90-195.90); n = 55 | 52.67 (16.89-116.73); n = 37 | 43.14 (10.90-195.90); n = 18 | 0.244 |
CKMB (U/L) | 7.80 (0.01–54.60); n = 68 | 7.61 (0.01–54.60); n = 50 | 7.85 (2.28–49.70); n = 18 | 0.416 |
LDH (U/L) | 179.90 (2.17–761.70); n = 69 | 169.13 (2.17–761.70); n = 50 | 209.66 (116.20-702.30); n = 19 | 0.001 |
ɑ-HBDH (U/L) | 133.59 (87.75–701.40); n = 66 | 126.96 (87.75–701.40); n = 48 | 169.50 (99.79–604.40); n = 18 | 0.005 |
D-dimer (mg/L) | 0.43 (0.02–27.94); n = 45 | 0.37 (0.07–4.97); n = 30 | 1.14 (0.02–27.94); n = 15 | 0.001 |
NT-proBNP (U/L) | 30.77 (0.01-515.18); n = 22 | 11.33 (0.01-112.76); n = 11 | 60.90 (23.94-515.81); n = 11 | 0.001 |
Procalcitonin (ng/ml) | 0.05 (0.02–0.90); n = 56 | 0.04 (0.02–0.45); n = 36 | 0.18 (0.02–0.90); n = 20 | < 0.001 |
IL-6 (pg/ml) | 3.64 (1.50–3392.00); n = 50 | 2.84 (1.50-268.30); n = 33 | 29.99 (1.50–3392.00); n = 17 | 0.001 |
WBC: white blood cell, NLR: Leukocyte to lymphocyte ratio, RBC: red blood cell, HB: Hemoglobin, PLT: platelet, CRP: C-reactive protein, ALT: Alanine transaminase, AST: Aspartate transaminase, A/G: Albumin to Globulin ratio, BUN: blood urea nitrogen, ALP: alkaline phosphatase, γ-GT: gamma-glutamyl transpeptidase, CK: creatine kinase, CKMB: MB isoenzyme of creatine kinase, LDH: lactate dehydrogenase, α-HBDH: alpha-hydroxybutyric dehydrogenase, NT-proBNP: N-terminal pro brain natriuretic peptide, IL-6: interleukin-6. |
There were 42 (40.8%) patients who had comorbidities, such as hypertension (35.9%), diabetes (13.6%), and heart disease (10.7%), of which 14 patients had two or more comorbidities. Among the 36 severe patients, 18 (50%) cases had comorbidities, while in the 67 non-severe patients 24 (35.8%) had comorbidities. A higher proportion of patients with diabetes or heart disease were observed in the severe group than in the non-severe group (Table 2).
The common clinical symptoms of cancer patients were fever (70.9%), cough (68%), dyspnea (23.3%), diarrhea (6.8%) and vomiting (4.9%). The percentage of patients with cough, vomiting or diarrhea showed no significant difference between the two groups except for a higher percentage of patients had dyspnea in the severe group than in the non-severe group (41.7% vs. 13.4%, P = 0.003) (Table 2).
The median level of white blood cell (WBC) count was 5.29×109 /L in all cancer patients, 4.77×109 /L in non-severe patients and 7.16×109 /L in severe patients. Similar results were found for neutrophil count. The median level of lymphocyte count was significantly lower in the severe group than in the non-severe group (0.80×109 /L vs. 1.23×109 /L, P = 0.003). In addition, a higher neutrophil-to-lymphocyte ratio (NLR) in severe patients was found (6.93 vs. 2.29, P < 0.001). The level of procalcitonin, C-reactive protein (CRP) and interleukin-6 (IL-6) was higher in severe patients than in non-severe patients (Table 2). When comparing hepatic function, renal function and biochemical indexes between severe and non-severe patients with cancer, we found that lactate dehydrogenase (LDH), alpha-hydroxybutyric dehydrogenase (αHBDH), D-dimer, N-terminal pro brain natriuretic peptide (NTproBNP), aspartate transaminase (AST) and Uric acid were higher while total protein, albumin and albumin/globulin were lower in the severe group (Table 2).
Propensity Score Matching Analysis
We performed a 1:2 (COVID-19 with cancer: COVID-19 without cancer) matched case-control analysis. When comparing clinical features on admission, we found that COVID-19 patients with cancer had a higher proportion of dyspnea than COVID-19 patients without cancer (23.3% vs. 10.2%, P = 0.003). No other significant differences were found. When comparing laboratory results between two groups, we found that the median lymphocyte count, monocytes count, eosinophils count and alanine transaminase (ALT) were lower in COVID-19 patients with cancer than in COVID-19 patients without cancer (Table 3). In contrast, the median NLR was higher in COVID-19 patients with cancer compared to counterpart. No significant differences were found in other laboratory results. The proportion of severe patients was similar between two groups (35% vs. 31%, P = 0.520). The proportion of deaths was much higher in COVID-19 patients with cancer than in COVID-19 patients without cancer (11.7% vs. 4.4%, P = 0.028) (Table 3).
Table 3
Comparison between COVID-19 patients with cancer and COVID-19 patients without cancer
Clinical features | All patients (n = 309) | Non-cancer patients (n = 206) | Cancer patients (n = 103) | P-value |
Age | 66.0 (20.0–95.0) | 66.00 (20.00–95.00) | 66.0(24.0–90.0) | 0.948 |
Sex | | | | 0.810 |
Female | 138 (44.7%) | 91 (44.1%) | 47 (45.6%) | |
Male | 171 (55.3%) | 115 (55.8%) | 56 (54.4%) | |
Comorbidities | | | | |
Diabetes | 37 (11.9) | 23 (11.1%) | 14 (13.6%) | 0.579 |
Hypertension | 96 (31.0%) | 59 (28.6%) | 37 (35.9%) | 0.195 |
Heart disease | 41 (13.2) | 30 (14.5%) | 11 (10.7%) | 0.379 |
Symptoms | | | | |
Fever | 234 (74.7%) | 161 (78.1) | 73 (70.9%) | 0.163 |
Cough | 207(66.9%) | 137 (66.5%) | 70 (68.0%) | 0.898 |
Dyspnea | 45 (14.6%) | 21 (10.2%) | 24 (23.3%) | 0.003 |
Vomiting | 10 (3.2%) | 5 (2.4%) | 5 (4.9%) | 0.310 |
Diarrhoea | 17 (5.5) | 10 (4.8%) | 7 (6.8%) | 0.597 |
Severity | | | | 0.520 |
Non-severe | 209 (67.6%) | 142 (68.9%) | 67 (65%) | |
Severe | 100 (32.4%) | 64 (31%) | 36 (35%) | |
Clinical outcome | | | | 0.028 |
Survivor | 288 (93.2%) | 197 (95.6%) | 91 (88.3%) | |
Non-survivor | 21 (6.8%) | 9 (4.4%) | 12 (11.7%) | |
Laboratory findings | | | | |
WBC (×109/L) | 5.50 (0.80–28.20); n = 306 | 5.60 (0.80–28.2); n = 206 | 5.29 (1.90–25.10); n = 100 | 0.381 |
Neutrophil (×109/L) | 3.25 (0.44–26.07); n = 306 | 3.23 (0.44–26.07); n = 206 | 3.49 (0.67–22.40); n = 100 | 0.164 |
Lymphocyte (×109/L) | 1.41 (0.60–3.50); n = 306 | 1.54 (0.60–3.50); n = 206 | 1.06 (0.22–2.89); n = 100 | < 0.001 |
NLR | 2.28 (0.20-62.12); n = 306 | 2.11 (0.20-62.12); n = 206 | 2.93 (0.64–32.23); n = 100 | < 0.001 |
Monocytes (×109/L) | 0.48 (0.03–1.16); n = 278 | 0.50 (0.03–1.16); n = 206 | 0.43 (0.11–1.11); n = 72 | 0.040 |
Eosnophils (×109/L) | 0.11 (0.00-0.90); n = 278 | 0.12 (0.00-0.72); n = 206 | 0.07 (0.00-0.90); n = 72 | < 0.001 |
Basophils (×109/L) | 0.03 (0.00-0.11); n = 278 | 0.03 (0.00-0.08); n = 206 | 0.02 (0.00-0.11); n = 72 | 0.076 |
RBC (×1012/L) | 3.93 (1.17–5.77); n = 279 | 3.93 (1.17–5.60); n = 206 | 3.95 (2.03–5.77); n = 73 | 0.406 |
HB (g/L) | 120.00 (53.00-166.00); n = 279 | 120.50 (53.00-166.00); n = 206 | 116.00 (68.00-154.00); n = 73 | 0.074 |
PLT (×109/L) | 209.50 (4.00-443.00) ; n = 278 | 213.00 (4.00-443.00) ; n = 206 | 203.00 (53.00-431.00); n = 72 | 0.120 |
CRP (mg/L) | 2.27 (0 .01-280.32); n = 251 | 2.16 (0.01–268.60) ; n = 161 | 2.52 (0.14-280.32); n = 90 | 0.147 |
ALT (U/L) | 21.67 (4.50-239.70); n = 301 | 23.35 (5.30-239.70); n = 204 | 19.17 (4.50-131.20); n = 97 | 0.047 |
AST (U/L) | 21.55 (9.60-502.40); n = 260 | 21.51 (9.60-502.40); n = 176 | 21.70 (10.00-147.20); n = 84 | 0.374 |
Total protein (g/L) | 65.5 (32.70-87.58); n = 276 | 65.81 (32.70–81.6); n = 205 | 64.99 (53.70-87.58); n = 71 | 0.528 |
Albumin (g/L) | 37.30 (18.3–48.00); n = 276 | 37.36 (18.30-45.55); n = 205 | 37.29 (23.60–48.00); n = 71 | 0.723 |
Globulin (g/L) | 27.73 (14.40-46.24); n = 276 | 27.70 (14.40-45.91); n = 205 | 28.00 (17.31–46.24); n = 71 | 0.417 |
A/G | 1.33 (0.39–2.65); n = 276 | 1.33 (0.70–2.65); n = 205 | 1.30 (0.39–2.20); n = 71 | 0.338 |
Total bilirubin (umol/L) | 10.00 (4.20-415.70); n = 274 | 9.76 (4.20-415.70); n = 204 | 10.32 (4.20-44.58); n = 70 | 0.514 |
Direct Bilirubin (umol/L) | 2.50 (0.00-326.70); n = 274 | 2.50 (0.00-326.70); n = 204 | 2.71 (0.00-23.90); n = 70 | 0.412 |
Indirect bilirubin (umol/L) | 7.18 (2.69–89.01); n = 274 | 7.17 (2.69–89.01); n = 204 | 7.39 (2.99–26.42); n = 70 | 0.883 |
BUN (umol/L) | 4.88 (2.23–36.08); n = 272 | 4.93 (2.23–36.08); n = 204 | 4.67 (2.68–29.61); n = 68 | 0.471 |
Creatinine (umol/L) | 60.00 (13.25-345.35); n = 273 | 60.87 (26.77–243.40); n = 203 | 57.72 (13.25-345.35); n = 70 | 0.509 |
Uric acid (umol/L) | 281.63 (69.00-600.56); n = 273 | 286.02 (69.00-600.56); n = 204 | 268.01 (100.00-575.95); n = 69 | 0.274 |
ALP (U/L) | 71.10 (31.90-493.30); n = 272 | 71.12 (31.90-366.10); n = 202 | 71.10 (42.59–493.30); n = 70 | 0.461 |
γ-GT (U/L) | 26.50 (7.64–263.6); n = 273 | 26.50 (7.64–242.2); n = 203 | 26.47 (8.15–263.60); n = 70 | 0.813 |
CKMB (U/L) | 44.31 (10.90–1210.00); n = 229 | 43.20 (11.00-1210.00); n = 174 | 48.40 (10.90-195.90); n = 55 | 0.084 |
LDH (U/L) | 175.35 (2.17-1489.89); n = 270 | 174.10 (99.90-489.89); n = 201 | 179.90 (2.17–761.70); n = 69 | 0.686 |
ɑ-HBDH (U/L) | 130.30 (79.66–1028.00); n = 267 | 129.80 (79.66–1028.00); n = 201 | 133.59 (87.75–701.40); n = 66 | 0.511 |
D-dimer (mg/L) | 7.72 (0.01–126.10); n = 272 | 7.71 (0.01–126.10); n = 204 | 7.80 (0.01–54.60); n = 68 | 0.498 |
NT-proBNP (U/L) | 43.94 (0.01–35000.00); n = 102 | 51.61(0.01–35000.00); n = 80 | 30.77 (0.01-515.18); n = 22 | 0.503 |
procalcitonin (ng/ml) | 0.045 (0.01–87.04); n = 200 | 0.042 (0.01–87.04); n = 144 | 0.05 (0.02–0.90); n = 56 | 0.231 |
IL-6 (pg/ml) | 3.20 (1.50–5000.00); n = 189 | 3.0 (1.50–5000.00); n = 139 | 3.64 (1.50–3392.00); n = 50 | 0.099 |
WBC: white blood cell, NLR: Leukocyte to lymphocyte ratio, RBC: red blood cell, HB: Hemoglobin, PLT: platelet, CRP: C-reactive protein, ALT: Alanine transaminase, AST: Aspartate transaminase, A/G: Albumin to Globulin ratio, BUN: blood urea nitrogen, ALP: alkaline phosphatase, γ-GT: gamma-glutamyl transpeptidase, CK: creatine kinase, CKMB: MB isoenzyme of creatine kinase, LDH: lactate dehydrogenase, α-HBDH: alpha-hydroxybutyric dehydrogenase, NT-proBNP: N-terminal pro brain natriuretic peptide, IL-6: interleukin-6. |
Nomogram For Predicting Death Outcome
As of April 15th, 2020, 12 out of 103 COVID-19 patients with cancer died in this study. To identify risk factors for death outcome and develop a nomogram, we excluded factors if the missing values were more than 20%. Hence, age, sex, smoking, comorbidities, symptoms, WBC count, Neutrophil count, Lymphocyte count, NLR, CRP, ALT and AST were included for further analysis. Comparison between survivors and non-survivors were performed. As shown in Table 4, when comparing clinical features, a higher proportion of dyspnea was found in non-survivors. No significant differences were found in other clinical features between two groups. When comparing laboratory results, we found that WBC count, neutrophil count, NLR and CRP were higher in non-survivors, while lymphocyte count was lower in non-survivors.
Table 4
Comparison between survivors and non-survivors in COVID-19 patients with cancer
Clinical features | All patients (n = 103) | Survivor (n = 91) | Non-survivor (n = 12) | P-value |
Age | 66.0(24.0–90.0) | 66(24.0–90.0) | 66(56.0–81.0) | 0.487 |
Sex | | | | 0.061 |
Female | 47 (45.6%) | 45 (44.6%) | 2 (16.7%) | |
Male | 56 (54.4%) | 56 (55.4%) | 10 (83.3%) | |
Smoking | 20 (19.4%) | 16 (17.6%) | 4 (33.3%) | 0.242 |
Comorbidities | | | | |
Diabetes | 14 (13.6%) | 13 (14.3%) | 1 (8.3%) | 1.000 |
Hypertension | 37 (35.9%) | 36 (39.6%) | 1 (8.3%) | 0.052 |
Heart disease | 11 (10.7%) | 9 (9.9%) | 2 (16.7%) | 0.613 |
Symptoms | | | | |
Fever | 73 (70.9%) | 63 (69.2%) | 10 (83.3%) | 0.501 |
Cough | 70 (68.0%) | 63 (69.2%) | 7 (58.3%) | 0.183 |
Dyspnea | 24 (23.3%) | 16(17.6%) | 8 (66.7%) | 0.003 |
Vomiting | 5 (4.9%) | 4 (4.4%) | 1 (8.3%) | 0.34 |
Diarrhoea | 7 (6.8%) | 6 (6.7%) | 1 (8.3%) | 0.235 |
Laboratory findings | | | | |
WBC (×109/L) | 8.10 (4.64–25.10); n = 98 | 5.04 (1.90–25.10); n = 86 | 7.36 (3.50–18.80); n = 12 | < 0.001 |
Neutrophil (×109/L) | 5.77 (2.74–22.40); n = 98 | 3.22 (0.67–22.40); n = 86 | 6.85 (1.50-17.36); n = 12 | < 0.001 |
Lymphocyte (×109/L) | 1.36 (.0.47–1.83); n = 98 | 1.15 (0.33–2.89); n = 86 | 0.64 (0.22–2.40); n = 12 | 0.01 |
NLR | 3.15 (1.70-25.51); n = 98 | 2.56 (0.64–24.76); n = 86 | 11.7 (2.88–32.32); n = 12 | < 0.001 |
CRP (mg/L) | 38.03 (1.45-137.52); n = 88 | 1.90 (0.14–177.80); n = 79 | 80.00 (4.80-280.32); n = 9 | < 0.001 |
ALT (U/L) | 19.17 (4.50-131.20); n = 95 | 19.17 (4.50-131.20); n = 83 | 16.50 (6.00-68.30); n = 12 | 0.649 |
AST (U/L) | 21.70 (10.00-147.20); n = 82 | 21.20 (10.00-147.20); n = 70 | 31.35 (12.00-92.6); n = 12 | 0.156 |
WBC: white blood cell, NLR: Leukocyte to lymphocyte ratio, CRP: C-reactive protein, ALT: Alanine transaminase, AST: Aspartate transaminase. |
Age, gender, smoking, number of comorbidities, number of symptoms, WBC, NLR, CRP, ALT, and AST were included in the generalized linear model. The results indicated that NLR and CRP were significant risk factors related to death outcome (Supplementary Table 1). A nomogram to predict the probability of death was developed based on the two factors (Fig. 2a). The AUC of the nomogram was 0.918 (95% confidence interval [CI] 0.860–0.977), which was higher than that of NLR (0.872, 95%CI 0.784–0.961) and CRP (0.880, 95%CI 0.803–0.958) (Fig. 2b). The calibration plot showed that the predicted outcomes were in high agreement with observed outcomes (Fig. 2c). The decision curve and clinical impact curve showed that the nomogram had superior net benefit and influence on the death outcome of patients (Fig. 2d-e).
For severe outcome, only NLR was significant factor in the generalized linear model (Supplementary Table 1), hence we didn’t develop a nomogram for predicting the probability of severity.