Integrating Anti-SARS-CoV-2 Spike Protein IgG, IL-6, and NK Cell Percentage with Routine Laboratory Markers for COVID-19 Severity Assessment: Development and Validation of the CORIS Nomogram.
- 1National Key Laboratory of Intelligent Tracking and Forecasting for Infectious Diseases, Beijing Key Laboratory of Viral Infectious Diseases, Department of Clinical Laboratory, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China.
- 2School of Medical Technology, Capital Medical University, Beijing 101300, China.
- 3Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China.
Abstract
Background: Rapid assessment of coronavirus disease 2019 (COVID-19) severity at hospital admission is essential for clinical triage and efficient healthcare resource allocation. However, prediction models developed using data from the early phases of the pandemic may exhibit reduced performance owing to the continued evolution of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants, and existing nomograms rarely integrate routine laboratory parameters with immune-related biomarkers in a systematic manner. Methods: We retrospectively included 774 patients with laboratory-confirmed COVID-19 admitted to Beijing Ditan Hospital between January 2022 and December 2023, and randomly assigned them at a 7:3 ratio to a training set (n = 543) and a validation set (n = 231). Variables consistently selected by three approaches-multivariable logistic regression, least absolute shrinkage and selection operator (LASSO) regression, and recursive feature elimination (RFE)-were defined as core predictors and used to construct the COVID Routine-Immune Score (CORIS) nomogram. Model performance was assessed in terms of discrimination, calibration, and clinical net benefit. The prespecified outcome was non-severe versus severe/critical status determined at hospital admission. CORIS was designed for admission severity discrimination and was not intended to diagnose SARS-CoV-2 infection or predict post-admission deterioration, survival, or thrombotic events. Results: Age, lactate dehydrogenase (LDH), anti-SARS-CoV-2 spike protein immunoglobulin G (IgG), interleukin-6 (IL-6), and NK cell percentage (NK-pct) were consistently identified by all three feature-selection methods. The CORIS nomogram achieved an area under the receiver operating characteristic curve (AUC) of 0.914 (95% CI, 0.884-0.940) in the training set and 0.918 (95% CI, 0.868-0.960) in the validation set, with good calibration (Hosmer-Lemeshow p = 0.322 and 0.659, respectively). In the validation set, the CORIS nomogram significantly outperformed a lymphocyte subset-based model (AUC, 0.811; DeLong p < 0.001) and a routine laboratory parameter-based model (AUC, 0.839; DeLong p = 0.003). Conclusions: The CORIS nomogram integrates predictors spanning four dimensions-demographic susceptibility, tissue injury, systemic inflammation, and immune status-to differentiate non-severe from severe or critical COVID-19. The model demonstrated favorable discrimination and calibration, and may provide an objective and practical tool for severity assessment at hospital admission.
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BibTeX
@article{zhang2026integrating,
title = {{Integrating Anti-SARS-CoV-2 Spike Protein IgG, IL-6, and NK Cell Percentage with Routine Laboratory Markers for COVID-19 Severity Assessment: Development and Validation of the CORIS Nomogram.}},
author = {Yihe Zhang and Xuanming Xu and Lian Tang and Jiayue Ma and Yajie Wang},
journal = {Diagnostics (Basel, Switzerland)},
year = {2026},
month = sep,
doi = {10.3390/diagnostics16193133},
url = {https://europepmc.org/article/MED/42882288},
note = {CC BY},
}
RIS
TY - JOUR
TI - Integrating Anti-SARS-CoV-2 Spike Protein IgG, IL-6, and NK Cell Percentage with Routine Laboratory Markers for COVID-19 Severity Assessment: Development and Validation of the CORIS Nomogram.
AU - Yihe Zhang
AU - Xuanming Xu
AU - Lian Tang
AU - Jiayue Ma
AU - Yajie Wang
PY - 2026
DA - 2026/09/26
JO - Diagnostics (Basel, Switzerland)
DO - 10.3390/diagnostics16193133
UR - https://europepmc.org/article/MED/42882288
AB - Background: Rapid assessment of coronavirus disease 2019 (COVID-19) severity at hospital admission is essential for clinical triage and efficient healthcare resource allocation. However, prediction models developed using data from the early phases of the pandemic may exhibit reduced performance owing to the continued evolution of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants, and existing nomograms rarely integrate routine laboratory parameters with immune-related biomarkers in a systematic manner. Methods: We retrospectively included 774 patients with laboratory-confirmed COVID-19 admitted to Beijing Ditan Hospital between January 2022 and December 2023, and randomly assigned them at a 7:3 ratio to a training set (n = 543) and a validation set (n = 231). Variables consistently selected by three approaches-multivariable logistic regression, least absolute shrinkage and selection operator (LASSO) regression, and recursive feature elimination (RFE)-were defined as core predictors and used to construct the COVID Routine-Immune Score (CORIS) nomogram. Model performance was assessed in terms of discrimination, calibration, and clinical net benefit. The prespecified outcome was non-severe versus severe/critical status determined at hospital admission. CORIS was designed for admission severity discrimination and was not intended to diagnose SARS-CoV-2 infection or predict post-admission deterioration, survival, or thrombotic events. Results: Age, lactate dehydrogenase (LDH), anti-SARS-CoV-2 spike protein immunoglobulin G (IgG), interleukin-6 (IL-6), and NK cell percentage (NK-pct) were consistently identified by all three feature-selection methods. The CORIS nomogram achieved an area under the receiver operating characteristic curve (AUC) of 0.914 (95% CI, 0.884-0.940) in the training set and 0.918 (95% CI, 0.868-0.960) in the validation set, with good calibration (Hosmer-Lemeshow p = 0.322 and 0.659, respectively). In the validation set, the CORIS nomogram significantly outperformed a lymphocyte subset-based model (AUC, 0.811; DeLong p < 0.001) and a routine laboratory parameter-based model (AUC, 0.839; DeLong p = 0.003). Conclusions: The CORIS nomogram integrates predictors spanning four dimensions-demographic susceptibility, tissue injury, systemic inflammation, and immune status-to differentiate non-severe from severe or critical COVID-19. The model demonstrated favorable discrimination and calibration, and may provide an objective and practical tool for severity assessment at hospital admission.
SN - 2075-4418
ER -