Prospective validation of the 4C prognostic models for adults hospitalised with COVID-19 using the ISARIC WHO Clinical Characterisation Protocol. Issue 6 (22nd November 2021)

• Record Type: Journal Article
• Authors: Knight, Stephen R; Gupta, Rishi K; Ho, Antonia; Pius, Riinu; Buchan, Iain; Carson, Gail; Drake, Thomas M; Dunning, Jake; Fairfield, Cameron J; Gamble, Carrol; Green, Christopher A; Halpin, Sophie; Hardwick, Hayley E; Holden, Karl A; Horby, Peter W; Jackson, Clare; Mclean, Kenneth A; Merson, Laura; Nguyen-Van-Tam, Jonathan S; Norman, Lisa; Olliaro, Piero L; Pritchard, Mark G; Russell, Clark D; Shaw, Catherine A; Sheikh, Aziz; Solomon, Tom; Sudlow, Cathie; Swann, Olivia V; Turtle, Lance C W; Openshaw, Peter J M; Baillie, J Kenneth; Docherty, Annemarie; Semple, Malcolm G; Noursadeghi, Mahdad; Harrison, Ewen M;
• Other Names: Kenneth Baillie J author non-byline.; Semple Malcolm G author non-byline.; Openshaw Peter JM author non-byline.; Carson Gail author non-byline.; Alex Beatrice author non-byline.; Bach Benjamin author non-byline.; Barclay Wendy S author non-byline.; Bogaert Debby author non-byline.; Chand Meera author non-byline.; Cooke Graham S author non-byline.; Docherty Annemarie B author non-byline.; Dunning Jake author non-byline.; Filipe Ana da Silva author non-byline.; Fletcher Tom author non-byline.; Green Christopher A author non-byline.; Harrison Ewen M author non-byline.; Hiscox Julian A author non-byline.; Ho Antonia YingWai author non-byline.; Horby Peter W author non-byline.; Ijaz Samreen author non-byline.; Khoo Saye author non-byline.; Klenerman Paul author non-byline.; Law Andrew author non-byline.; Lim Wei Shen author non-byline.; Alexander J Mentzer author non-byline.; Merson Laura author non-byline.; Meynert Alison M author non-byline.; Noursadeghi Mahdad author non-byline.; Moore Shona C author non-byline.; Palmarini Massimo author non-byline.; Paxton William A author non-byline.; Pollakis Georgios author non-byline.; Price Nicholas author non-byline.; Rambaut Andrew author non-byline.; Robertson David L author non-byline.; Russell Clark D author non-byline.; Sancho-Shimizu Vanessa author non-byline.; Scott Janet T author non-byline.; Sigfrid Louise author non-byline.; Solomon Tom author non-byline.; Sriskandan Shiranee author non-byline.; Stuart David author non-byline.; Summers Charlotte author non-byline.; Tedder Richard S author non-byline.; Thomson Emma C author non-byline.; Thwaites Ryan S author non-byline.; Turtle Lance CW author non-byline.; Zambon Maria author non-byline.; Hardwick Hayley author non-byline.; Donohue Chloe author non-byline.; Ewins Jane author non-byline.; Oosthuyzen Wilna author non-byline.; Griffiths Fiona author non-byline.; Norman Lisa author non-byline.; Pius Riinu author non-byline.; Drake Tom M author non-byline.; Fairfield Cameron J author non-byline.; Knight Stephen R author non-byline.; Mclean Kenneth A author non-byline.; Murphy Derek author non-byline.; Shaw Catherine A author non-byline.; Dalton Jo author non-byline.; Girvan Michelle author non-byline.; Saviciute Egle author non-byline.; Roberts Stephanie author non-byline.; Harrison Janet author non-byline.; Marsh Laura author non-byline.; Connor Marie author non-byline.; Halpin Sophie author non-byline.; Jackson Clare author non-byline.; Gamble Carrol author non-byline.; Leeming Gary author non-byline.; Law Andrew author non-byline.; Hendry Ross author non-byline.; Greenhalf William author non-byline.; Shaw Victoria author non-byline.; McDonald Sarah author non-byline.; Ahmed Katie A author non-byline.; Armstrong Jane A author non-byline.; Ashworth Milton author non-byline.; Asiimwe Innocent G author non-byline.; Bakshi Siddharth author non-byline.; Barlow Samantha L author non-byline.; Booth Laura author non-byline.; Brennan Benjamin author non-byline.; Bullock Katie author non-byline.; Catterall Benjamin WA author non-byline.; Clark Jordan J author non-byline.; Clarke Emily A author non-byline.; Cole Sarah author non-byline.; Cooper Louise author non-byline.; Cox Helen author non-byline.; Davis Christopher author non-byline.; Dincarslan Oslem author non-byline.; Dunn Chris author non-byline.; Dyer Philip author non-byline.; Elliott Angela author non-byline.; Evans Anthony author non-byline.; Fisher Lewis WS author non-byline.; Foster Terry author non-byline.; Garcia-Dorival Isabel author non-byline.; Greenhalf Willliam author non-byline.; Gunning Philip author non-byline.; Hartley Catherine author non-byline.; Ho Antonia author non-byline.; Jensen Rebecca L author non-byline.; Jones Christopher B author non-byline.; Jones Trevor R author non-byline.; Khandaker Shadia author non-byline.; King Katharine author non-byline.; Kiy Robyn T author non-byline.; Koukorava Chrysa author non-byline.; Lake Annette author non-byline.; Lant Suzannah author non-byline.; Latawiec Diane author non-byline.; Lavelle-Langham L author non-byline.; Lefteri Daniella author non-byline.; Lett Lauren author non-byline.; Livoti Lucia A author non-byline.; Mancini Maria author non-byline.; McDonald Sarah author non-byline.; McEvoy Laurence author non-byline.; McLauchlan John author non-byline.; Metelmann Soeren author non-byline.; Miah Nahida S author non-byline.; Middleton Joanna author non-byline.; Mitchell Joyce author non-byline.; Moore Shona C author non-byline.; Murphy Ellen G author non-byline.; Penrice-Randal Rebekah author non-byline.; Pilgrim Jack author non-byline.; Prince Tessa author non-byline.; Reynolds Will author non-byline.; Matthew Ridley P author non-byline.; Sales Debby author non-byline.; Shaw Victoria E author non-byline.; Shears Rebecca K author non-byline.; Small Benjamin author non-byline.; Subramaniam Krishanthi S author non-byline.; Szemiel Agnieska author non-byline.; Taggart Aislynn author non-byline.; Tanianis-Hughes Jolanta author non-byline.; Thomas Jordan author non-byline.; Trochu Erwan author non-byline.; Tonder Libby van author non-byline.; Wilcock Eve author non-byline.; Eunice Zhang J author non-byline.; Adeniji Kayode author non-byline.; Agranoff Daniel author non-byline.; Agwuh Ken author non-byline.; Ail Dhiraj author non-byline.; Alegria Ana author non-byline.; Angus Brian author non-byline.; Ashish Abdul author non-byline.; Atkinson Dougal author non-byline.; Bari Shahedal author non-byline.; Barlow Gavin author non-byline.; Barnass Stella author non-byline.; Barrett Nicholas author non-byline.; Bassford Christopher author non-byline.; Baxter David author non-byline.; Beadsworth Michael author non-byline.; Bernatoniene Jolanta author non-byline.; Berridge John author non-byline.; Best Nicola author non-byline.; Bothma Pieter author non-byline.; Brealey David author non-byline.; Brittain-Long Robin author non-byline.; Bulteel Naomi author non-byline.; Burden Tom author non-byline.; Burtenshaw Andrew author non-byline.; Caruth Vikki author non-byline.; Chadwick David author non-byline.; Chambler Duncan author non-byline.; Chee Nigel author non-byline.; Child Jenny author non-byline.; Chukkambotla Srikanth author non-byline.; Clark Tom author non-byline.; Collini Paul author non-byline.; Cosgrove Catherine author non-byline.; Cupitt Jason author non-byline.; Cutino-Moguel Maria-Teresa author non-byline.; Dark Paul author non-byline.; Dawson Chris author non-byline.; Dervisevic Samir author non-byline.; Donnison Phil author non-byline.; Douthwaite Sam author non-byline.; DuRand Ingrid author non-byline.; Dushianthan Ahilanadan author non-byline.; Dyer Tristan author non-byline.; Evans Cariad author non-byline.; Eziefula Chi author non-byline.; Fegan Chrisopher author non-byline.; Finn Adam author non-byline.; Fullerton Duncan author non-byline.; Garg Sanjeev author non-byline.; Garg Sanjeev author non-byline.; Garg Atul author non-byline.; Godden Jo author non-byline.; Goldsmith Arthur author non-byline.; Graham Clive author non-byline.; Hardy Elaine author non-byline.; Hartshorn Stuart author non-byline.; Harvey Daniel author non-byline.; Havalda Peter author non-byline.; Hawcutt Daniel B author non-byline.; Hobrok Maria author non-byline.; Hodgson Luke author non-byline.; Holme Anita author non-byline.; Hormis Anil author non-byline.; Jacobs Michael author non-byline.; Jain Susan author non-byline.; Jennings Paul author non-byline.; Kaliappan Agilan author non-byline.; Kasipandian Vidya author non-byline.; Kegg Stephen author non-byline.; Kelsey Michael author non-byline.; Kendall Jason author non-byline.; Kerrison Caroline author non-byline.; Kerslake Ian author non-byline.; Koch Oliver author non-byline.; Koduri Gouri author non-byline.; Koshy George author non-byline.; Laha Shondipon author non-byline.; Larkin Susan author non-byline.; Leiner Tamas author non-byline.; Lillie Patrick author non-byline.; Limb James author non-byline.; Linnett Vanessa author non-byline.; Little Jeff author non-byline.; MacMahon Michael author non-byline.; MacNaughton Emily author non-byline.; Mankregod Ravish author non-byline.; Masson Huw author non-byline.; Matovu Elijah author non-byline.; McCullough Katherine author non-byline.; McEwen Ruth author non-byline.; Meda Manjula author non-byline.; Mills Gary author non-byline.; Minton Jane author non-byline.; Mirfenderesky Mariyam author non-byline.; Mohandas Kavya author non-byline.; Mok Quen author non-byline.; Moon James author non-byline.; Moore Elinoor author non-byline.; Morgan Patrick author non-byline.; Morris Craig author non-byline.; Mortimore Katherine author non-byline.; Moses Samuel author non-byline.; Mpenge Mbiye author non-byline.; Mulla Rohinton author non-byline.; Murphy Michael author non-byline.; Nagel Megan author non-byline.; Nagarajan Thapas author non-byline.; Nelson Mark author non-byline.; Otahal Igor author non-byline.; Pais Mark author non-byline.; Panchatsharam Selva author non-byline.; Paraiso Hassan author non-byline.; Patel Brij author non-byline.; Pepperell Justin author non-byline.; Peters Mark author non-byline.; Phull Mandeep author non-byline.; Pintus Stefania author non-byline.; Pooni Jagtur Singh author non-byline.; Post Frank author non-byline.; Price David author non-byline.; Prout Rachel author non-byline.; Rae Nikolas author non-byline.; Reschreiter Henrik author non-byline.; Reynolds Tim author non-byline.; Richardson Neil author non-byline.; Roberts Mark author non-byline.; Roberts Devender author non-byline.; Rose Alistair author non-byline.; Rousseau Guy author non-byline.; Ryan Brendan author non-byline.; Saluja Taranprit author non-byline.; Shah Aarti author non-byline.; Shanmuga Prad author non-byline.; Sharma Anil author non-byline.; Shawcross Anna author non-byline.; Sizer Jeremy author non-byline.; Smith Richard author non-byline.; Snelson Catherine author non-byline.; Spittle Nick author non-byline.; Staines Nikki author non-byline.; Stambach Tom author non-byline.; Stewart Richard author non-byline.; Subudhi Pradeep author non-byline.; Szakmany Tamas author non-byline.; Tatham Kate author non-byline.; Thomas Jo author non-byline.; Thompson Chris author non-byline.; Thompson Robert author non-byline.; Tridente Ascanio author non-byline.; Tupper-Carey Darell author non-byline.; Twagira Mary author non-byline.; Ustianowski Andrew author non-byline.; Vallotton Nick author non-byline.; Vincent-Smith Lisa author non-byline.; Visuvanathan Shico author non-byline.; Vuylsteke Alan author non-byline.; Waddy Sam author non-byline.; Wake Rachel author non-byline.; Walden Andrew author non-byline.; Welters Ingeborg author non-byline.; Whitehouse Tony author non-byline.; Whittaker Paul author non-byline.; Whittington Ashley author non-byline.; Wijesinghe Meme author non-byline.; Williams Martin author non-byline.; Wilson Lawrence author non-byline.; Wilson Sarah author non-byline.; Winchester Stephen author non-byline.; Wiselka Martin author non-byline.; Wolverson Adam author non-byline.; Wooton Daniel G author non-byline.; Workman Andrew author non-byline.; Yates Bryan author non-byline.; Young Peter author non-byline.;
• Is Part Of: Thorax. Volume 77:Issue 6(2022)
• Page Start: 606
• Page End: 615
• Publication Date: 2021-11-22
• Subjects: COVID-19; Chest -- Diseases -- Periodicals; Thorax; Chest -- Diseases; Periodicals; Periodicals; 617.54
• DOI: 10.1136/thoraxjnl-2021-217629
• Languages: English
• ISSNs: 0040-6376

Abstract

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 .