In:
Thorax, BMJ, Vol. 77, No. 6 ( 2022-06), p. 606-615
Abstract:
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. Trial registration number NCT66726260 .
Type of Medium:
Online Resource
ISSN:
0040-6376
,
1468-3296
DOI:
10.1136/thoraxjnl-2021-217629
Language:
English
Publisher:
BMJ
Publication Date:
2022
detail.hit.zdb_id:
1481491-2
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