Development and validation of the 4C Deterioration model for adults hospitalised with COVID-19

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Gupta, Rishi ORCID: 0000-0002-6257-1285, Harrison, Ewen ORCID: 0000-0002-5018-3066, Ho, Antonia ORCID: 0000-0003-1465-3785, Docherty, Annemarie, Knight, Stephen, van Smeden, Maarten ORCID: 0000-0002-5529-1541, Abubakar, Ibrahim ORCID: 0000-0002-0370-1430, Lipman, Marc ORCID: 0000-0001-7501-4448, Quartagno, Matteo ORCID: 0000-0003-4446-0730, Pius, Riinu et al (show 30 more authors) , Buchan, Iain ORCID: 0000-0003-3392-1650, Carson, Gail, Drake, Thomas, Dunning, Jake ORCID: 0000-0002-4035-4562, Fairfield, Cameron, Gamble, Carrol ORCID: 0000-0002-3021-1955, Green, Christopher ORCID: 0000-0002-1984-4014, Halpin, Sophie, Hardwick, Hayley, Holden, Karl, Horby, Peter ORCID: 0000-0002-9822-1586, Jackson, Clare, Mclean, Kenneth, Merson, Laura, Nguyen-Van-Tam, Jonathan, Norman, Lisa, Olliaro, Piero, Pritchard, Mark, Russell, Clark, Scott-Brown, James, Shaw, Catherine, Sheikh, Aziz, Solomon, Tom ORCID: 0000-0001-7266-6547, Sudlow, Cathie, Swann, Olivia ORCID: 0000-0001-7386-2849, Turtle, Lance ORCID: 0000-0002-0778-1693, Openshaw, Peter JM, Baillie, Kenneth, Semple, Malcolm ORCID: 0000-0001-9700-0418 and Noursadeghi, Mahdad ORCID: 0000-0002-4774-0853 (2020) Development and validation of the 4C Deterioration model for adults hospitalised with COVID-19 medRxiv. 2020.10.09.20209957-. ISSN 3067-2007

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Abstract

Prognostic models to predict the risk of clinical deterioration in acute COVID-19 are required to inform clinical management decisions. Among 75,016 consecutive adults across England, Scotland and Wales prospectively recruited to the ISARIC Coronavirus Clinical Characterisation Consortium (ISARIC4C) study, we developed and validated a multivariable logistic regression model for in-hospital clinical deterioration (defined as any requirement of ventilatory support or critical care, or death) using 11 routinely measured variables. We used internal-external cross-validation to show consistent measures of discrimination, calibration and clinical utility across eight geographical regions. We further validated the final model in held-out data from 8,252 individuals in London, with similarly consistent performance (C-statistic 0.77 (95% CI 0.75 to 0.78); calibration-in-the-large 0.01 (−0.04 to 0.06); calibration slope 0.96 (0.90 to 1.02)). Importantly, this model demonstrated higher net benefit than using other candidate scores to inform decision-making. Our 4C Deterioration model thus demonstrates unprecedented clinical utility and generalisability to predict clinical deterioration among adults hospitalised with COVID-19.

Item Type:	Article
Uncontrolled Keywords:	32 Biomedical and Clinical Sciences, 3202 Clinical Sciences, 42 Health Sciences, Infectious Diseases, Emerging Infectious Diseases, Lung, Prevention, Patient Safety, Coronaviruses, Clinical Research
Depositing User:	Symplectic Admin
Date Deposited:	08 Jan 2021 15:13
Last Modified:	26 Feb 2026 19:58
DOI:	10.1101/2020.10.09.20209957
Open Access URL:	https://doi.org/10.1101/2020.10.09.20209957
Related Websites:	Publisher
URI:	https://livrepository.liverpool.ac.uk/id/eprint/3112061
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