ArticleScientific reports2021
External validation of the 4C mortality score among COVID-19 patients admitted to hospital in Ontario, Canada: a retrospective study.
Article in Scientific reports, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 24 papers.
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Who cites it
24 citing papers in PubMed.
- Wave-aware mortality prediction in COVID-19: a multi-stage feature selection and explainable machine-learning framework.BMC medical informatics and decision making · 2026Article
- Predictive accuracy of 4C Mortality Score and Acute Physiology and Chronic Health Evaluation scores for mortality in COVID-19 patients admitted to intensive care unit.World journal of critical care medicine · 2025Article
- Validation of the age, neutrophil to lymphocyte ratio, C reactive protein score on 28 day mortality in the National COVID cohort collaborative.Scientific reports · 2025Article
- Performance of Risk Scores in SARS-CoV-2 Infection: A Retrospective Study.International journal of environmental research and public health · 2025Observational
- External Validation of the Predictive Accuracy of Clinical and Immunological Scores in COVID-19 Outcomes in a Retrospective Cohort Study.Biomedicines · 2024Article
- At-admission prediction of mortality and pulmonary embolism in an international cohort of hospitalised patients with COVID-19 using statistical and machine learning methods.Scientific reports · 2024Article
- COVID-19: The Development and Validation of a New Mortality Risk Score.Journal of clinical medicine · 2024Article
- Investigating the relationship between the immune response and the severity of COVID-19: a large-cohort retrospective study.Frontiers in immunology · 2024Observational
- Validation of the SACOV-19 score for identifying patients at risk of complicated or more severe COVID-19: a prospective study.Infection · 2023Article
- Comparison of different prognostic scores in estimating short- and long-term mortality in COVID-19 patients above 60 years old in a university hospital in Belgium.European geriatric medicine · 2023Observational
- ANCOC Score to Predict Mortality in Different SARS-CoV-2 Variants and Vaccination Status.Journal of clinical medicine · 2023Article
- External validation of the ISARIC 4C Mortality Score to predict in-hospital mortality among patients with COVID-19 in a Canadian intensive care unit: a single-centre historical cohort study.Canadian journal of anaesthesia = Journal canadien d'anesthesie · 2023Article
- Utility of the 4C ISARIC mortality score in hospitalized COVID-19 patients at a large tertiary Saudi Arabian center.Multidisciplinary respiratory medicine · 2023Article
- Mechanical ventilation and death in pregnant patients admitted for COVID-19: a prognostic analysis from the Brazilian COVID-19 registry score.BMC pregnancy and childbirth · 2023Article
- Soluble ST2 as a Useful Biomarker for Predicting Clinical Outcomes in Hospitalized COVID-19 Patients.Diagnostics (Basel, Switzerland) · 2023Article
- Is the 4C Score Still a Valid Item to Predict In-Hospital Mortality in People with SARS-CoV-2 Infections in the Omicron Variant Era?Life (Basel, Switzerland) · 2023Article
- External Validation of COVID-19 Risk Scores during Three Waves of Pandemic in a German Cohort-A Retrospective Study.Journal of personalized medicine · 2022Article
- Stratification of patients admitted for SARS-CoV2 infection: prognostic scores in the first and second wave of the pandemic.Internal and emergency medicine · 2022Article
- External Validation of Mortality Scores among High-Risk COVID-19 Patients: A Romanian Retrospective Study in the First Pandemic Year.Journal of clinical medicine · 2022Article
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14 authors.
Funding
Abstract
Risk prediction scores are important tools to support clinical decision-making for patients with coronavirus disease (COVID-19). The objective of this paper was to validate the 4C mortality score, originally developed in the United Kingdom, for a Canadian population, and to examine its performance over time. We conducted an external validation study within a registry of COVID-19 positive hospital admissions in the Kitchener-Waterloo and Hamilton regions of southern Ontario between March 4, 2020 and June 13, 2021. We examined the validity of the 4C score to prognosticate in-hospital mortality using the area under the receiver operating characteristic curve (AUC) with 95% confidence intervals calculated via bootstrapping. The study included 959 individuals, of whom 224 (23.4%) died in-hospital. Median age was 72 years and 524 individuals (55%) were male. The AUC of the 4C score was 0.77, 95% confidence interval 0.79-0.87. Overall mortality rates across the pre-defined risk groups were 0% (Low), 8.0% (Intermediate), 27.2% (High), and 54.2% (Very High). Wave 1, 2 and 3 values of the AUC were 0.81 (0.76, 0.86), 0.74 (0.69, 0.80), and 0.76 (0.69, 0.83) respectively. The 4C score is a valid tool to prognosticate mortality from COVID-19 in Canadian hospitals and can be used to prioritize care and resources for patients at greatest risk of death.
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