RT Journal Article
SR Electronic
T1 Prospective validation of the 4C prognostic models for adults hospitalised with COVID-19 using the ISARIC WHO Clinical Characterisation Protocol
JF Thorax
JO Thorax
FD BMJ Publishing Group Ltd and British Thoracic Society
SP thoraxjnl-2021-217629
DO 10.1136/thoraxjnl-2021-217629
A1 Stephen R Knight
A1 Rishi K Gupta
A1 Antonia Ho
A1 Riinu Pius
A1 Iain Buchan
A1 Gail Carson
A1 Thomas M Drake
A1 Jake Dunning
A1 Cameron J Fairfield
A1 Carrol Gamble
A1 Christopher A Green
A1 Sophie Halpin
A1 Hayley E Hardwick
A1 Karl A Holden
A1 Peter W Horby
A1 Clare Jackson
A1 Kenneth A Mclean
A1 Laura Merson
A1 Jonathan S Nguyen-Van-Tam
A1 Lisa Norman
A1 Piero L Olliaro
A1 Mark G Pritchard
A1 Clark D Russell
A1 Catherine A Shaw
A1 Aziz Sheikh
A1 Tom Solomon
A1 Cathie Sudlow
A1 Olivia V Swann
A1 Lance C W Turtle
A1 Peter J M Openshaw
A1 J Kenneth Baillie
A1 Annemarie Docherty
A1 Malcolm G Semple
A1 Mahdad Noursadeghi
A1 Ewen M Harrison
A1 ,
A1 ,
YR 2021
UL http://thorax.bmj.com/content/early/2021/11/21/thoraxjnl-2021-217629.abstract
AB 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.Access to all data and samples collected by ISARIC4C are controlled by an Independent Data and Materials Access Committee composed of representatives of research funders, academia, clinical medicine, public health, and industry. The application process for access to the data is available on the ISARIC4C website (https://isaric4c.net/sample_access/).