Knight, Stephen R, Gupta, Rishi K, Ho, Antonia, Pius, Riinu, Buchan, Iain 
ORCID: 0000-0003-3392-1650, Carson, Gail, Drake, Thomas M, Dunning, Jake, Fairfield, Cameron J, Gamble, Carrol ORCID: 0000-0002-3021-1955 et al (show 25 more authors)
(2022)
Prospective validation of the 4C prognostic models for adults hospitalised with COVID-19 using the ISARIC WHO Clinical Characterisation Protocol.
THORAX, 77 (6).
pp. 606-615.
Abstract
<h4>Purpose</h4>To prospectively validate two risk scores to predict mortality (4C Mortality) and in-hospital deterioration (4C Deterioration) among adults hospitalised with COVID-19.<h4>Methods</h4>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.<h4>Results</h4>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.<h4>Conclusion</h4>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.<h4>Trial registration number</h4>ISRCTN66726260.
| Item Type: | Article |
|---|---|
| Uncontrolled Keywords: | ISARIC Coronavirus Clinical Characterisation Consortium (ISARIC4C) Investigators, ISARIC4C investigators, Humans, Prognosis, Hospital Mortality, Adolescent, Adult, World Health Organization, State Medicine, Observational Studies as Topic, COVID-19, SARS-CoV-2 |
| Divisions: | Faculty of Health and Life Sciences Faculty of Health and Life Sciences > Institute of Infection, Veterinary and Ecological Sciences |
| Depositing User: | Symplectic Admin |
| Date Deposited: | 01 Dec 2021 09:18 |
| Last Modified: | 18 Jan 2023 21:23 |
| DOI: | 10.1136/thoraxjnl-2021-217629 |
| Open Access URL: | https://thorax.bmj.com/content/early/2021/11/21/th... |
| Related URLs: | |
| URI: | https://livrepository.liverpool.ac.uk/id/eprint/3144292 |
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