Academic Journal
Prospective validation of the 4C prognostic models for adults hospitalised with COVID-19 using the ISARIC WHO Clinical Characterisation Protocol
| Title: | Prospective validation of the 4C prognostic models for adults hospitalised with COVID-19 using the ISARIC WHO Clinical Characterisation Protocol |
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| Authors: | Knight, SR, Gupta, RK, Ho, A, Pius, R, Buchan, I, Carson, G, Drake, TM, Dunning, J, Fairfield, CJ, Gamble, C, Green, CA, Halpin, S, Hardwick, HE, Holden, KA, Horby, PW, Jackson, C, Mclean, KA, Merson, L, Nguyen-Van-Tam, JS, Norman, L, Olliaro, PL, Pritchard, MG, Russell, CD, Shaw, CA, Sheikh, A, Solomon, T, Sudlow, C, Swann, OV, Turtle, LCW, Openshaw, PJM, Baillie, JK, Docherty, A, Semple, MG, Noursadeghi, M, Harrison, EM, ISARIC Coronavirus Clinical Characterisation Consortium (ISARIC4,, ISARIC4C investigators, . |
| Source: | Thorax (2021) (In press). |
| Publication Year: | 2021 |
| Collection: | University College London: UCL Discovery |
| Subject Terms: | COVID-19 |
| Description: | 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. |
| Document Type: | article in journal/newspaper |
| File Description: | text |
| Language: | English |
| Relation: | https://discovery.ucl.ac.uk/id/eprint/10139383/ |
| Availability: | https://discovery.ucl.ac.uk/id/eprint/10139383/1/thoraxjnl-2021-217629.full.pdf https://discovery.ucl.ac.uk/id/eprint/10139383/ |
| Rights: | open |
| Accession Number: | edsbas.FCBF34BF |
| Database: | BASE |
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