Warning indicators of COVID-19 severity: a retrospective observational study integrating modern biomarkers and traditional tongue features

ObjectiveThis study aims to identify early warning indicators of COVID-19 severity by integrating modern medical biomarkers with traditional Chinese medicine (TCM) tongue features.MethodsA retrospective observational study was conducted on 409 hospitalized COVID-19 patients from two centers in China...

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Main Authors: Zhang Jing, Liu Yuntao, Zheng Danwen, Ye Gangfu, Chen Qiumin, Huang Jianshan, Wang Jiamei, Ma Zengming, Zhang Zhongde
Format: Article
Language:English
Published: Frontiers Media S.A. 2025-04-01
Series:Frontiers in Medicine
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Online Access:https://www.frontiersin.org/articles/10.3389/fmed.2025.1500605/full
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author Zhang Jing
Zhang Jing
Liu Yuntao
Zheng Danwen
Ye Gangfu
Chen Qiumin
Huang Jianshan
Wang Jiamei
Ma Zengming
Zhang Zhongde
author_facet Zhang Jing
Zhang Jing
Liu Yuntao
Zheng Danwen
Ye Gangfu
Chen Qiumin
Huang Jianshan
Wang Jiamei
Ma Zengming
Zhang Zhongde
author_sort Zhang Jing
collection DOAJ
description ObjectiveThis study aims to identify early warning indicators of COVID-19 severity by integrating modern medical biomarkers with traditional Chinese medicine (TCM) tongue features.MethodsA retrospective observational study was conducted on 409 hospitalized COVID-19 patients from two centers in China. Patients were stratified into severe (n = 50) and non-severe (n = 359) groups based on the 10th edition of China’s diagnostic guidelines. Data included demographics, clinical symptoms, tongue characteristics, and laboratory parameters. Univariate analyses (chi-square/Fisher’s exact tests) and stepwise logistic regression were performed to identify key predictors.ResultsAge (p < 0.001), fever (p < 0.001), elevated procalcitonin (PCT, p < 0.001), thick tongue fur (p = 0.003), and fat tongue shape (p = 0.002) were significant predictors of severity. The combined model integrating these factors demonstrated superior predictive performance (Nagelkerke R2 = 0.741).ConclusionIntegrating TCM tongue features (thick fur and fat shape) with clinical biomarkers (age, fever, and PCT) enhances early identification of severe COVID-19, particularly in resource-limited settings.
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publisher Frontiers Media S.A.
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spelling doaj-art-8cd4085de6e044828e6a8d80d2ac7e972025-08-20T03:08:32ZengFrontiers Media S.A.Frontiers in Medicine2296-858X2025-04-011210.3389/fmed.2025.15006051500605Warning indicators of COVID-19 severity: a retrospective observational study integrating modern biomarkers and traditional tongue featuresZhang Jing0Zhang Jing1Liu Yuntao2Zheng Danwen3Ye Gangfu4Chen Qiumin5Huang Jianshan6Wang Jiamei7Ma Zengming8Zhang Zhongde9Department of Pulmonary and Critical Care Medicine, Xiamen Hospital of Traditional Chinese Medicine, Xiamen, Fujian, ChinaGuangzhou University of Chinese Medicine, Guangzhou, Guangdong, ChinaKey Laboratory of Infectious Diseases, Guangdong Provincial Bureau of Chinese Medicine, Guangzhou, ChinaEmergency Department, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, ChinaDepartment of Pulmonary and Critical Care Medicine, Xiamen Hospital of Traditional Chinese Medicine, Xiamen, Fujian, ChinaDepartment of Traditional Chinese Medicine, Xinglin Branch of the First Affiliated Hospital of Xiamen University, Xiamen, Fujian, ChinaDepartment of Pediatrics, Xiamen Hospital of Traditional Chinese Medicine, Xiamen, Fujian, ChinaDepartment of Traditional Chinese Medicine, Xiamen Fifth Hospital, Xiamen, Fujian, ChinaIntegrated TCM & Western Medicine Department, Xiamen Xianyue Hospital, Xiamen, Fujian, ChinaKey Laboratory of Infectious Diseases, Guangdong Provincial Bureau of Chinese Medicine, Guangzhou, ChinaObjectiveThis study aims to identify early warning indicators of COVID-19 severity by integrating modern medical biomarkers with traditional Chinese medicine (TCM) tongue features.MethodsA retrospective observational study was conducted on 409 hospitalized COVID-19 patients from two centers in China. Patients were stratified into severe (n = 50) and non-severe (n = 359) groups based on the 10th edition of China’s diagnostic guidelines. Data included demographics, clinical symptoms, tongue characteristics, and laboratory parameters. Univariate analyses (chi-square/Fisher’s exact tests) and stepwise logistic regression were performed to identify key predictors.ResultsAge (p < 0.001), fever (p < 0.001), elevated procalcitonin (PCT, p < 0.001), thick tongue fur (p = 0.003), and fat tongue shape (p = 0.002) were significant predictors of severity. The combined model integrating these factors demonstrated superior predictive performance (Nagelkerke R2 = 0.741).ConclusionIntegrating TCM tongue features (thick fur and fat shape) with clinical biomarkers (age, fever, and PCT) enhances early identification of severe COVID-19, particularly in resource-limited settings.https://www.frontiersin.org/articles/10.3389/fmed.2025.1500605/fullCOVID-19severity predictiontraditional Chinese medicinetongue diagnosisbiomarkers
spellingShingle Zhang Jing
Zhang Jing
Liu Yuntao
Zheng Danwen
Ye Gangfu
Chen Qiumin
Huang Jianshan
Wang Jiamei
Ma Zengming
Zhang Zhongde
Warning indicators of COVID-19 severity: a retrospective observational study integrating modern biomarkers and traditional tongue features
Frontiers in Medicine
COVID-19
severity prediction
traditional Chinese medicine
tongue diagnosis
biomarkers
title Warning indicators of COVID-19 severity: a retrospective observational study integrating modern biomarkers and traditional tongue features
title_full Warning indicators of COVID-19 severity: a retrospective observational study integrating modern biomarkers and traditional tongue features
title_fullStr Warning indicators of COVID-19 severity: a retrospective observational study integrating modern biomarkers and traditional tongue features
title_full_unstemmed Warning indicators of COVID-19 severity: a retrospective observational study integrating modern biomarkers and traditional tongue features
title_short Warning indicators of COVID-19 severity: a retrospective observational study integrating modern biomarkers and traditional tongue features
title_sort warning indicators of covid 19 severity a retrospective observational study integrating modern biomarkers and traditional tongue features
topic COVID-19
severity prediction
traditional Chinese medicine
tongue diagnosis
biomarkers
url https://www.frontiersin.org/articles/10.3389/fmed.2025.1500605/full
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