| Title: |
Prospective validation of the 4C prognostic models for adults hospitalised with COVID-19 using the ISARIC WHO Clinical Characterisation Protocol |
| 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 |