{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T22:12:04Z","timestamp":1789164724609,"version":"build-2803163510"},"reference-count":79,"publisher":"Public Library of Science (PLoS)","issue":"5","license":[{"start":{"date-parts":[[2026,5,29]],"date-time":"2026-05-29T00:00:00Z","timestamp":1780012800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100007601","name":"Horizon 2020","doi-asserted-by":"publisher","award":["101003673"],"award-info":[{"award-number":["101003673"]}],"id":[{"id":"10.13039\/501100007601","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Since its emergence, the COVID-19 infection has led to significant morbidity and mortality worldwide. Early identification of patients at risk for severe disease is essential for more effective triage, timely therapeutic intervention, and optimal resource allocation. Differences in population characteristics may contribute to variability in disease outcomes, which emphasizes the need for regional-level data, especially from underrepresented regions. The main aim of this study was to identify the demographic, clinical, and laboratory predictors of severe COVID-19, defined as the need for oxygen therapy, in Lithuania.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Materials and methods<\/jats:title>\n                    <jats:p>We conducted an ambispective observational cohort study at Vilnius University Hospital Santaros Klinikos in Vilnius, Lithuania, from March 2020 to December 2021. Adult patients with a confirmed diagnosis of COVID-19 and hospitalized longer than 24 hours were included in this study. Data were collected from the electronic medical records and patient interviews. To identify predictors of severe COVID-19 course, a multivariable binary logistic regression model was performed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 495 patients, 52.9% were male, the median age was 55 years, and 61.2% had at least one underlying condition. The most common symptoms on admission were malaise (77.1%), subfebrile fever (65.9%), and cough (69.7%). CRP demonstrated the highest predictive value for severe COVID-19 (AUC\u2009=\u20090.84), followed by LDH (AUC\u2009=\u20090.80). Older age (OR 1.04 per year, 95% CI 1.00\u20131.08), obesity (OR 3.55, 95% CI 1.35\u20139.30), lymphopenia (OR 3.70, 95% CI 1.37\u20139.99), higher LDH (OR 1.008, 95% CI 1.00\u20131.01) and CRP (OR 1.021, 95% CI 1.01\u20131.04) levels were identified as the strongest predictors for severe COVID-19 disease course.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Older age, obesity, lymphopenia, and higher CRP and LDH were associated with developing severe COVID-19 disease, indicating that combining patient history and laboratory parameters can provide a practical risk stratification approach to help clinicians identify high-risk patients early upon hospitalisation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0350112","type":"journal-article","created":{"date-parts":[[2026,5,29]],"date-time":"2026-05-29T17:28:45Z","timestamp":1780075725000},"page":"e0350112","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":1,"title":["Predicting severe COVID-19 disease in adults: A single-centre cohort study during the first three pandemic waves in 2020\u20132021 in Vilnius, Lithuania"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4220-6053","authenticated-orcid":true,"given":"Ieva","family":"Kubiliute","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-1199-4645","authenticated-orcid":true,"given":"Edgaras","family":"Zaboras","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fausta","family":"Majauskaite","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jurgita","family":"Urboniene","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Birute","family":"Zablockiene","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9952-9446","authenticated-orcid":true,"given":"Giedre","family":"Gefenaite","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aukse","family":"Mickiene","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6488-6312","authenticated-orcid":true,"given":"Ligita","family":"Jancoriene","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,5,29]]},"reference":[{"issue":"13","key":"pone.0350112.ref001","doi-asserted-by":"crossref","first-page":"1239","DOI":"10.1001\/jama.2020.2648","article-title":"Characteristics 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Villar-Garc\u00eda","year":"2020","journal-title":"medRxiv"},{"key":"pone.0350112.ref038","doi-asserted-by":"crossref","first-page":"1523139","DOI":"10.3389\/fmed.2025.1523139","article-title":"The clinical features and outcomes of diabetes patients infected with COVID-19: a systematic review and meta-analysis comprising 192,693 patients","volume":"12","author":"K Liu","year":"2025","journal-title":"Front Med (Lausanne)"},{"issue":"11","key":"pone.0350112.ref039","doi-asserted-by":"crossref","first-page":"3791","DOI":"10.3390\/jcm12113791","article-title":"The complex association between COPD and COVID-19","volume":"12","author":"NT Awatade","year":"2023","journal-title":"J Clin Med"},{"issue":"8","key":"pone.0350112.ref040","doi-asserted-by":"crossref","first-page":"2765","DOI":"10.3390\/jcm14082765","article-title":"Chronic obstructive pulmonary disease and COVID-19: the impact of hematological biomarkers on disease severity and outcomes","volume":"14","author":"G Mara","year":"2025","journal-title":"J Clin Med"},{"key":"pone.0350112.ref041","doi-asserted-by":"crossref","first-page":"106640","DOI":"10.1016\/j.rmed.2021.106640","article-title":"COPD is a risk factor for COVID-19, but does not confer increased severity of the disease","volume":"189","author":"JS Jeong","year":"2021","journal-title":"Respir Med"},{"issue":"1","key":"pone.0350112.ref042","doi-asserted-by":"crossref","first-page":"90","DOI":"10.1007\/s12016-022-08921-5","article-title":"Risk and protective factors for COVID-19 morbidity, severity, and mortality","volume":"64","author":"J Zhang","year":"2023","journal-title":"Clin Rev Allergy Immunol"},{"issue":"9","key":"pone.0350112.ref043","doi-asserted-by":"crossref","first-page":"769","DOI":"10.1038\/s43587-021-00114-7","article-title":"SARS-CoV-2, COVID-19 and the ageing immune system","volume":"1","author":"JM Bartleson","year":"2021","journal-title":"Nat 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mortal COVID-19 cases: a systematic literature review and meta-analysis","volume":"81","author":"Z Zheng","year":"2020","journal-title":"J Infect"},{"issue":"3","key":"pone.0350112.ref048","doi-asserted-by":"crossref","first-page":"335","DOI":"10.1111\/joim.13089","article-title":"Clinical and epidemiological characteristics of 1420 European patients with mild-to-moderate coronavirus disease 2019","volume":"288","author":"JR Lechien","year":"2020","journal-title":"J Intern Med"},{"issue":"8","key":"pone.0350112.ref049","doi-asserted-by":"crossref","first-page":"1081","DOI":"10.1001\/jamainternmed.2020.2033","article-title":"Development and validation of a clinical risk score to predict the occurrence of critical illness in hospitalized patients with COVID-19","volume":"180","author":"W Liang","year":"2020","journal-title":"JAMA Intern Med"},{"issue":"11","key":"pone.0350112.ref050","doi-asserted-by":"crossref","first-page":"5336","DOI":"10.1002\/jmv.28007","article-title":"Early predictors of clinical deterioration in a cohort of outpatients with COVID-19 in southern Italy: a multicenter observational study","volume":"94","author":"C Monari","year":"2022","journal-title":"J Med Virol"},{"issue":"1","key":"pone.0350112.ref051","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1002\/rmv.2146","article-title":"Predictors of COVID-19 severity: a literature review","volume":"31","author":"B Gallo Marin","year":"2021","journal-title":"Rev Med Virol"},{"key":"pone.0350112.ref052","doi-asserted-by":"crossref","unstructured":"Kumar A, Arora A, Sharma P, Anikhindi SA, Bansal N, Singla V. Clinical features of COVID-19 and factors associated with severe clinical course: a systematic review and meta-analysis. 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Prev Pract"},{"issue":"4","key":"pone.0350112.ref056","doi-asserted-by":"crossref","first-page":"321","DOI":"10.1002\/jhm.13063","article-title":"Diagnostic delays among COVID-19 patients with a second concurrent diagnosis","volume":"18","author":"O Freund","year":"2023","journal-title":"J Hosp Med"},{"issue":"1","key":"pone.0350112.ref057","doi-asserted-by":"crossref","first-page":"18197","DOI":"10.1038\/s41598-024-68946-y","article-title":"A predictive model to explore risk factors for severe COVID-19","volume":"14","author":"FH Qian","year":"2024","journal-title":"Scientific Reports"},{"issue":"9","key":"pone.0350112.ref058","doi-asserted-by":"crossref","first-page":"1722","DOI":"10.1016\/j.ajem.2020.05.073","article-title":"Lactate dehydrogenase levels predict coronavirus disease 2019 (COVID-19) severity and mortality: a pooled analysis","volume":"38","author":"BM Henry","year":"2020","journal-title":"Am J Emerg 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associated with severe coronavirus disease 2019 (COVID-19) infections: a systemic review and meta-analysis","volume":"96","author":"Q Zhao","year":"2020","journal-title":"Int J Infect Dis"},{"issue":"9","key":"pone.0350112.ref063","doi-asserted-by":"crossref","DOI":"10.1371\/journal.ppat.1009850","article-title":"Neutrophils and lymphopenia, an unknown axis in severe COVID-19 disease","volume":"17","author":"HF Pe\u00f1aloza","year":"2021","journal-title":"PLoS Pathog"},{"issue":"1","key":"pone.0350112.ref064","doi-asserted-by":"crossref","first-page":"1040","DOI":"10.1186\/s12879-021-06662-y","article-title":"Early predictors and screening tool developing for severe patients with COVID-19","volume":"21","author":"L Fang","year":"2021","journal-title":"BMC Infect Dis"},{"issue":"6","key":"pone.0350112.ref065","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0270192","article-title":"Clinical characteristics and risk factors for COVID-19 infection and disease severity: a 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