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ORIGINAL RESEARCH article
Front. Med.
Sec. Translational Medicine
Volume 12 - 2025 | doi: 10.3389/fmed.2025.1500605
Warning Indicators of Severity in COVID-19: A Retrospective Observational Study Integrating Modern Biomarkers and Traditional Tongue Features
Provisionally accepted
Zhang Jing 1
Yuntao Liu 2
Zheng Danwen 3 Ye Gangfu 1 Chen Qiumin 4 Huang Jianshan 1 Wang Jiamei 5 Ma Zengming 6 Zhang Zhongde 2*- 1 Xiamen Hospital of Traditional Chinese Medicine, Xiamen, China
- 2 Key Laboratory of Infectious Diseases, Guangdong Provincial Bureau of Chinese Medicine, Guangdong, China
- 3 The Second Affiliated Hospital, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
- 4 Xinglin Branch of the First Affiliated Hospital of Xiamen University, Xiamen, China
- 5 Xiamen Fifth Hospital, Xiamen, Fujian Province, China
- 6 Xiamen Xianyue Hospital, Xiamen, Fujian Province, China
Objective To identify early warning indicators of COVID-19 severity by integrating modern medical biomarkers with traditional Chinese medicine (TCM) tongue features. Methods A retrospective observational study was conducted on 409 hospitalized COVID-19 patients from two centers in China. Patients were stratified into severe (n = 50) and nonsevere (n = 359) groups based on China's 10th edition 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. Results Age ( 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). Conclusion Integrating TCM tongue features (thick fur, fat shape) with clinical biomarkers (age, fever, PCT) enhances early identification of severe COVID-19, particularly in resourcelimited settings.
Keywords: COVID-19, Severity prediction, Traditional Chinese Medicine, Tongue diagnosis, biomarkers
Received: 23 Sep 2024; Accepted: 19 Mar 2025.
Copyright: © 2025 Jing, Liu, Danwen, Gangfu, Qiumin, Jianshan, Jiamei, Zengming and Zhongde. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Zhang Zhongde, Key Laboratory of Infectious Diseases, Guangdong Provincial Bureau of Chinese Medicine, Guangdong, China
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