Contributors: Baillie, JK; Semple, MG; Openshaw, PJM; Carson, G; Alex, B; Bach, B; Barclay, WS; Bogaert, D; Chand, M; Cooke, GS; Docherty, AB; Dunning, J; Da Silva Filipe, A; Fletcher, T; Green, CA; Harrison, EM; Hiscox, JA; Ho, AYW; Horby, PW; Ijaz, S; Khoo, S; Klenerman, P; Law, A; Lim, WS; Mentzer, AJ; Merson, L; Meynert, AM; Noursadeghi, M; Moore, SC; Palmarini, M; Paxton, WA; Pollakis, G; Price, N; Rambaut, A; Robertson, DL; Russell, CD; Sancho-Shimizu, V; Scott, JT; Sigfrid, L; Solomon, T; Sriskandan, S; Stuart, D; Summers, C; Tedder, RS; Thomson, EC; Thwaites, RS; Turtle, LCW; Zambon, M; Hardwick, H; Donohue, C; Ewins, J; Oosthuyzen, W; Griffiths, F; Norman, L; Pius, R; Drake, TM; Fairfield, CJ; Knight, S; Mclean, KA; Murphy, D; Shaw, CA; Dalton, J; Girvan, M; Saviciute, E; Roberts, S; Harrison, J; Marsh, L; Connor, M; Halpin, S; Jackson, C; Gamble, C; Leeming, G; Hendry, R; Scott-Brown, J; Greenhalf, W; Shaw, V; McDonald, S; Ahmed, KA; Armstrong, JA; Ashworth, M; Asiimwe, IG; Bakshi, S; Barlow, SL; Booth, L; Brennan, B; Bullock, K; Catterall, BWA; Clark, JJ; Clarke, EA; Cole, S; Cooper, L; Cox, H; Davis, C; Dincarslan, O; Dunn, C; Dyer, P; Elliott, A; Evans, A; Fisher, LWS
نبذة مختصرة : Objective To develop and validate a pragmatic risk score to predict mortality in patients admitted to hospital with coronavirus disease 2019 (covid-19).Design Prospective observational cohort study.Setting International Severe Acute Respiratory and emerging Infections Consortium (ISARIC) World Health Organization (WHO) Clinical Characterisation Protocol UK (CCP-UK) study (performed by the ISARIC Coronavirus Clinical Characterisation Consortium—ISARIC-4C) in 260 hospitals across England, Scotland, and Wales. Model training was performed on a cohort of patients recruited between 6 February and 20 May 2020, with validation conducted on a second cohort of patients recruited after model development between 21 May and 29 June 2020.Participants Adults (age >=18 years) admitted to hospital with covid-19 at least four weeks before final data extraction.Main outcome measure In-hospital mortality.Results 35 463 patients were included in the derivation dataset (mortality rate 32.2%) and 22 361 in the validation dataset (mortality rate 30.1%). The final 4C Mortality Score included eight variables readily available at initial hospital assessment: age, sex, number of comorbidities, respiratory rate, peripheral oxygen saturation, level of consciousness, urea level, and C reactive protein (score range 0-21 points). The 4C Score showed high discrimination for mortality (derivation cohort: area under the receiver operating characteristic curve 0.79, 95% confidence interval 0.78 to 0.79; validation cohort: 0.77, 0.76 to 0.77) with excellent calibration (validation: calibration-in-the-large=0, slope=1.0). Patients with a score of at least 15 (n=4158, 19%) had a 62% mortality (positive predictive value 62%) compared with 1% mortality for those with a score of 3 or less (n=1650, 7%; negative predictive value 99%). Discriminatory performance was higher than 15 pre-existing risk stratification scores (area under the receiver operating characteristic curve range 0.61-0.76), with scores developed in other covid-19 cohorts often ...
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