TY - JOUR 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 SP - 606 LP - 615 DO - 10.1136/thoraxjnl-2021-217629 VL - 77 IS - 6 AU - Stephen R Knight AU - Rishi K Gupta AU - Antonia Ho AU - Riinu Pius AU - Iain Buchan AU - Gail Carson AU - Thomas M Drake AU - Jake Dunning AU - Cameron J Fairfield AU - Carrol Gamble AU - Christopher A Green AU - Sophie Halpin AU - Hayley E Hardwick AU - Karl A Holden AU - Peter W Horby AU - Clare Jackson AU - Kenneth A Mclean AU - Laura Merson AU - Jonathan S Nguyen-Van-Tam AU - Lisa Norman AU - Piero L Olliaro AU - Mark G Pritchard AU - Clark D Russell AU - Catherine A Shaw AU - Aziz Sheikh AU - Tom Solomon AU - Cathie Sudlow AU - Olivia V Swann AU - Lance C W Turtle AU - Peter J M Openshaw AU - J Kenneth Baillie AU - Annemarie Docherty AU - Malcolm G Semple AU - Mahdad Noursadeghi AU - Ewen M Harrison A2 - , , Y1 - 2022/06/01 UR - http://thorax.bmj.com/content/77/6/606.abstract N2 - 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/). We welcome applications for data and material access via our Independent Data And Material Access Committee (https://isaric4c.net). ER -