PMID- 35450898
OWN - NLM
STAT- MEDLINE
DCOM- 20220425
LR  - 20231105
IS  - 2044-6055 (Electronic)
IS  - 2044-6055 (Linking)
VI  - 12
IP  - 4
DP  - 2022 Apr 21
TI  - External validation of the 4C Mortality Score for hospitalised patients with 
      COVID-19 in the RECOVER network.
PG  - e054700
LID - 10.1136/bmjopen-2021-054700 [doi]
AB  - OBJECTIVES: Estimating mortality risk in hospitalised SARS-CoV-2+ patients may 
      help with choosing level of care and discussions with patients. The Coronavirus 
      Clinical Characterisation Consortium Mortality Score (4C Score) is a promising 
      COVID-19 mortality risk model. We examined the association of risk factors with 
      30-day mortality in hospitalised, full-code SARS-CoV-2+ patients and investigated 
      the discrimination and calibration of the 4C Score. This was a retrospective 
      cohort study of SARS-CoV-2+ hospitalised patients within the RECOVER (REgistry of 
      suspected COVID-19 in EmeRgency care) network. SETTING: 99 emergency departments 
      (EDs) across the USA. PARTICIPANTS: Patients >/=18 years old, positive for 
      SARS-CoV-2 in the ED, and hospitalised. PRIMARY OUTCOME: Death within 30 days of 
      the index visit. We performed logistic regression analysis, reporting 
      multivariable risk ratios (MVRRs) and calculated the area under the ROC curve 
      (AUROC) and mean prediction error for the original 4C Score and after dropping 
      the C reactive protein (CRP) component. RESULTS: Of 6802 hospitalised patients 
      with COVID-19, 1149 (16.9%) died within 30 days. The 30-day mortality was 
      increased with age 80+ years (MVRR=5.79, 95% CI 4.23 to 7.34); male sex 
      (MVRR=1.17, 1.05 to 1.28); and nursing home/assisted living facility residence 
      (MVRR=1.29, 1.1 to 1.48). The 4C Score had comparable discrimination in the 
      RECOVER dataset compared with the original 4C validation dataset (AUROC: RECOVER 
      0.786 (95% CI 0.773 to 0.799), 4C validation 0.763 (95% CI 0.757 to 0.769). 
      Score-specific mortalities in our sample were lower than in the 4C validation 
      sample (mean prediction error 6.0%). Dropping the CRP component from the 4C Score 
      did not substantially affect discrimination and 4C risk estimates were now close 
      (mean prediction error 0.7%). CONCLUSIONS: We independently validated 4C Score as 
      predicting risk of 30-day mortality in hospitalised SARS-CoV-2+ patients. We 
      recommend dropping the CRP component of the score and using our recalibrated 
      mortality risk estimates.
CI  - (c) Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No 
      commercial re-use. See rights and permissions. Published by BMJ.
FAU - Gordon, Alexandra June
AU  - Gordon AJ
AUID- ORCID: 0000-0002-1866-8565
AD  - Emergency Medicine, Stanford University School of Medicine, Stanford, California, 
      USA.
FAU - Govindarajan, Prasanthi
AU  - Govindarajan P
AD  - Emergency Medicine, Stanford University School of Medicine, Stanford, California, 
      USA.
FAU - Bennett, Christopher L
AU  - Bennett CL
AD  - Emergency Medicine, Stanford University School of Medicine, Stanford, California, 
      USA.
AD  - Epidemiology, Stanford University School of Medicine, Stanford, California, USA.
FAU - Matheson, Loretta
AU  - Matheson L
AD  - Emergency Medicine, Stanford University School of Medicine, Stanford, California, 
      USA.
FAU - Kohn, Michael A
AU  - Kohn MA
AD  - Emergency Medicine, Stanford University School of Medicine, Stanford, California, 
      USA.
AD  - Epidemiology and Biostatistics, University of California San Francisco, San 
      Francisco, California, USA.
FAU - Camargo, Carlos
AU  - Camargo C
AD  - Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, 
      Boston, Massachusetts, USA.
FAU - Kline, Jeffrey
AU  - Kline J
AUID- ORCID: 0000-0001-7190-3109
AD  - Emergency Medicine, Wayne State University School of Medicine, Detroit, Michigan, 
      USA jkline@wayne.edu.
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20220421
PL  - England
TA  - BMJ Open
JT  - BMJ open
JID - 101552874
SB  - IM
MH  - Adolescent
MH  - Aged, 80 and over
MH  - *COVID-19
MH  - Hospital Mortality
MH  - Humans
MH  - Male
MH  - Retrospective Studies
MH  - Risk Factors
MH  - SARS-CoV-2
PMC - PMC9023850
OTO - NOTNLM
OT  - ACCIDENT & EMERGENCY MEDICINE
OT  - Adult intensive & critical care
OT  - COVID-19
OT  - EPIDEMIOLOGY
OT  - GENERAL MEDICINE (see Internal Medicine)
COIS- Competing interests: None declared.
EDAT- 2022/04/23 06:00
MHDA- 2022/04/26 06:00
CRDT- 2022/04/22 07:04
PHST- 2022/04/22 07:04 [entrez]
PHST- 2022/04/23 06:00 [pubmed]
PHST- 2022/04/26 06:00 [medline]
AID - bmjopen-2021-054700 [pii]
AID - 10.1136/bmjopen-2021-054700 [doi]
PST - epublish
SO  - BMJ Open. 2022 Apr 21;12(4):e054700. doi: 10.1136/bmjopen-2021-054700.