TY - JOUR
AU - Knight, Stephen R.
AU - Gupta, Rishi K.
AU - Ho, Antonia
AU - Pius, Riinu
AU - Buchan, Iain
AU - Carson, Gail
AU - Drake, Thomas M.
AU - Dunning, Jake
AU - Fairfield, Cameron J.
AU - Gamble, Carrol
AU - Green, Christopher A.
AU - Halpin, Sophie
AU - Hardwick, Hayley E.
AU - Holden, Karl A.
AU - Horby, Peter W.
AU - Jackson, Clare
AU - McLean, Kenneth A.
AU - Merson, Laura
AU - Nguyen-Van-Tam, Jonathan S.
AU - Norman, Lisa
AU - Olliaro, Piero L.
AU - Pritchard, Mark G.
AU - Russell, Clark D.
AU - Shaw, Catherine A.
AU - Sheikh, Aziz
AU - Solomon, Tom
AU - Sudlow, Cathie L.M.
AU - Swann, Olivia V.
AU - Turtle, Lance C.W.
AU - Openshaw, Peter J.M.
AU - Baillie, J. Kenneth
AU - Docherty, Annemarie B.
AU - Semple, Malcolm G.
AU - Noursadeghi, Mahdad
AU - Harrison, Ewen M.
PY - 2021
DA - November
TI - Prospective validation of the 4C prognostic models for adults hospitalised with covid-19 using the ISARIC WHO Clinical Characterisation Protocol
JO - Thorax
EP - 615
VL - 77
IS - 6
DO - http://dx.doi.org/10.1136/thoraxjnl-2021-217629
AB - Purpose: To prospectively validate two risk scores to predict mortality (4C Mortality) and in-hospital deterioration (4C Deterioration) among adults hospitalised with COVID-19. Methods: Prospective observational cohort study of adults (age ≥18 years) with confirmed or highly suspected COVID-19 recruited into the International Severe Acute Respiratory and emerging Infections Consortium (ISARIC) WHO Clinical Characterisation Protocol UK (CCP-UK) study in 306 hospitals across England, Scotland and Wales. Patients were recruited between 27 August 2020 and 17 February 2021, with at least 4 weeks follow-up before final data extraction. The main outcome measures were discrimination and calibration of models for in-hospital deterioration (defined as any requirement of ventilatory support or critical care, or death) and mortality, incorporating predefined subgroups. Results: 76 588 participants were included, of whom 27 352 (37.4%) deteriorated and 12 581 (17.4%) died. Both the 4C Mortality (0.78 (0.77 to 0.78)) and 4C Deterioration scores (pooled C-statistic 0.76 (95% CI 0.75 to 0.77)) demonstrated consistent discrimination across all nine National Health Service regions, with similar performance metrics to the original validation cohorts. Calibration remained stable (4C Mortality: pooled slope 1.09, pooled calibration-in-the-large 0.12; 4C Deterioration: 1.00, –0.04), with no need for temporal recalibration during the second UK pandemic wave of hospital admissions. Conclusion: Both 4C risk stratification models demonstrate consistent performance to predict clinical deterioration and mortality in a large prospective second wave validation cohort of UK patients. Despite recent advances in the treatment and management of adults hospitalised with COVID-19, both scores can continue to inform clinical decision making.
PB - BMJ Publishing Group
UR - http://eprints.gla.ac.uk/257554/
KW - Coronavirus (COVID-19)
ER