tetano
Editor, Senior Moderator
Thorax
. 2021 Nov 22;thoraxjnl-2021-217629.
doi: 10.1136/thoraxjnl-2021-217629. Online ahead of print.
Prospective validation of the 4C prognostic models for adults hospitalised with COVID-19 using the ISARIC WHO Clinical Characterisation Protocol
Stephen R Knight[SUP] 1 [/SUP], Rishi K Gupta[SUP] 2 [/SUP], Antonia Ho[SUP] 3 [/SUP], Riinu Pius[SUP] 1 [/SUP], Iain Buchan[SUP] 4 5 [/SUP], Gail Carson[SUP] 6 [/SUP], Thomas M Drake[SUP] 1 [/SUP], Jake Dunning[SUP] 7 8 [/SUP], Cameron J Fairfield[SUP] 1 [/SUP], Carrol Gamble[SUP] 9 [/SUP], Christopher A Green[SUP] 10 [/SUP], Sophie Halpin[SUP] 9 [/SUP], Hayley E Hardwick[SUP] 11 [/SUP], Karl A Holden[SUP] 11 [/SUP], Peter W Horby[SUP] 6 [/SUP], Clare Jackson[SUP] 9 [/SUP], Kenneth A Mclean[SUP] 1 [/SUP], Laura Merson[SUP] 6 [/SUP], Jonathan S Nguyen-Van-Tam[SUP] 12 [/SUP], Lisa Norman[SUP] 1 [/SUP], Piero L Olliaro[SUP] 13 [/SUP], Mark G Pritchard[SUP] 13 [/SUP], Clark D Russell[SUP] 14 [/SUP], Catherine A Shaw[SUP] 1 [/SUP], Aziz Sheikh[SUP] 15 [/SUP], Tom Solomon[SUP] 11 [/SUP], Cathie Sudlow[SUP] 16 [/SUP], Olivia V Swann[SUP] 17 [/SUP], Lance C W Turtle[SUP] 18 19 [/SUP], Peter J M Openshaw[SUP] 20 [/SUP], J Kenneth Baillie[SUP] 21 [/SUP], Annemarie Docherty[SUP] 1 [/SUP], Malcolm G Semple[SUP] 11 22 [/SUP], Mahdad Noursadeghi[SUP] 23 [/SUP], Ewen M Harrison[SUP] 24 [/SUP], ISARIC Coronavirus Clinical Characterisation Consortium (ISARIC4C) Investigators; ISARIC4C investigators
Collaborators, Affiliations
Abstract
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.
Trial registration number: ISRCTN66726260.
Keywords: COVID-19.
. 2021 Nov 22;thoraxjnl-2021-217629.
doi: 10.1136/thoraxjnl-2021-217629. Online ahead of print.
Prospective validation of the 4C prognostic models for adults hospitalised with COVID-19 using the ISARIC WHO Clinical Characterisation Protocol
Stephen R Knight[SUP] 1 [/SUP], Rishi K Gupta[SUP] 2 [/SUP], Antonia Ho[SUP] 3 [/SUP], Riinu Pius[SUP] 1 [/SUP], Iain Buchan[SUP] 4 5 [/SUP], Gail Carson[SUP] 6 [/SUP], Thomas M Drake[SUP] 1 [/SUP], Jake Dunning[SUP] 7 8 [/SUP], Cameron J Fairfield[SUP] 1 [/SUP], Carrol Gamble[SUP] 9 [/SUP], Christopher A Green[SUP] 10 [/SUP], Sophie Halpin[SUP] 9 [/SUP], Hayley E Hardwick[SUP] 11 [/SUP], Karl A Holden[SUP] 11 [/SUP], Peter W Horby[SUP] 6 [/SUP], Clare Jackson[SUP] 9 [/SUP], Kenneth A Mclean[SUP] 1 [/SUP], Laura Merson[SUP] 6 [/SUP], Jonathan S Nguyen-Van-Tam[SUP] 12 [/SUP], Lisa Norman[SUP] 1 [/SUP], Piero L Olliaro[SUP] 13 [/SUP], Mark G Pritchard[SUP] 13 [/SUP], Clark D Russell[SUP] 14 [/SUP], Catherine A Shaw[SUP] 1 [/SUP], Aziz Sheikh[SUP] 15 [/SUP], Tom Solomon[SUP] 11 [/SUP], Cathie Sudlow[SUP] 16 [/SUP], Olivia V Swann[SUP] 17 [/SUP], Lance C W Turtle[SUP] 18 19 [/SUP], Peter J M Openshaw[SUP] 20 [/SUP], J Kenneth Baillie[SUP] 21 [/SUP], Annemarie Docherty[SUP] 1 [/SUP], Malcolm G Semple[SUP] 11 22 [/SUP], Mahdad Noursadeghi[SUP] 23 [/SUP], Ewen M Harrison[SUP] 24 [/SUP], ISARIC Coronavirus Clinical Characterisation Consortium (ISARIC4C) Investigators; ISARIC4C investigators
Collaborators, Affiliations
- PMID: 34810237
- DOI: 10.1136/thoraxjnl-2021-217629
Abstract
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.
Trial registration number: ISRCTN66726260.
Keywords: COVID-19.