AUTHOR=Jing Zhang , Yuntao Liu , Danwen Zheng , Gangfu Ye , Qiumin Chen , Jianshan Huang , Jiamei Wang , Zengming Ma , Zhongde Zhang 

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

JOURNAL=Frontiers in Medicine

VOLUME=Volume 12 - 2025

YEAR=2025

URL=https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2025.1500605

DOI=10.3389/fmed.2025.1500605

ISSN=2296-858X

ABSTRACT=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.