@article{Knight:2021:10.1136/thoraxjnl-2021-217629,
author = {Knight, SR and Gupta, RK and Ho, A and Pius, R and Buchan, I and Carson, G and Drake, TM and Dunning, J and Fairfield, CJ and Gamble, C and Green, CA and Halpin, S and Hardwick, HE and Holden, KA and Horby, PW and Jackson, C and Mclean, KA and Merson, L and Nguyen-Van-Tam, JS and Norman, L and Olliaro, PL and Pritchard, MG and Russell, CD and Shaw, CA and Sheikh, A and Solomon, T and Sudlow, C and Swann, O and Turtle, LCW and Openshaw, PJM and Baillie, JK and Docherty, A and Semple, MG and Noursadeghi, M and Harrison, EM},
doi = {10.1136/thoraxjnl-2021-217629},
journal = {Thorax},
pages = {1--10},
title = {Prospective validation of the 4C prognostic models for adults hospitalised with COVID-19 using the ISARIC WHO Clinical Characterisation Protocol},
url = {http://dx.doi.org/10.1136/thoraxjnl-2021-217629},
volume = {77},
year = {2021}
}

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TY  - JOUR
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.
AU  - Knight,SR
AU  - Gupta,RK
AU  - Ho,A
AU  - Pius,R
AU  - Buchan,I
AU  - Carson,G
AU  - Drake,TM
AU  - Dunning,J
AU  - Fairfield,CJ
AU  - Gamble,C
AU  - Green,CA
AU  - Halpin,S
AU  - Hardwick,HE
AU  - Holden,KA
AU  - Horby,PW
AU  - Jackson,C
AU  - Mclean,KA
AU  - Merson,L
AU  - Nguyen-Van-Tam,JS
AU  - Norman,L
AU  - Olliaro,PL
AU  - Pritchard,MG
AU  - Russell,CD
AU  - Shaw,CA
AU  - Sheikh,A
AU  - Solomon,T
AU  - Sudlow,C
AU  - Swann,O
AU  - Turtle,LCW
AU  - Openshaw,PJM
AU  - Baillie,JK
AU  - Docherty,A
AU  - Semple,MG
AU  - Noursadeghi,M
AU  - Harrison,EM
DO  - 10.1136/thoraxjnl-2021-217629
EP  - 10
PY  - 2021///
SN  - 0040-6376
SP  - 1
TI  - Prospective validation of the 4C prognostic models for adults hospitalised with COVID-19 using the ISARIC WHO Clinical Characterisation Protocol
T2  - Thorax
UR  - http://dx.doi.org/10.1136/thoraxjnl-2021-217629
UR  - http://gateway.webofknowledge.com/gateway/Gateway.cgi?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=WOS:000721905000001&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=1ba7043ffcc86c417c072aa74d649202
UR  - https://thorax.bmj.com/content/early/2021/11/21/thoraxjnl-2021-217629
UR  - http://hdl.handle.net/10044/1/93570
VL  - 77
ER  - 

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