ArticleBMJ open2022
External validation of the 4C Mortality Score for hospitalised patients with COVID-19 in the RECOVER network.
Article in BMJ open, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT05498324 (External Validation of the 4C Mortality Score for Hospitalised Patients With COVID-19 in a Tunisian Cohort), which is not on this map. Cited by 9 papers, 1 of them a synthesis that pooled it.
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External Validation of the 4C Mortality Score for Hospitalised Patients With COVID-19 in a Tunisian Cohort
Who cites it
9 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Prognostic models in COVID-19 infection that predict severity: a systematic review.European journal of epidemiology · 2023Pooled it
- [Performance of prognostic scores during the first and second waves of COVID-19 pneumonia]Revista de la Facultad de Ciencias Medicas (Cordoba, Argentina) · 2026Article
- Prediction models based on machine learning algorithms for COVID-19 severity risk.BMC public health · 2025Article
- Article
- Discrimination of a single-item scale to measure intention to have a COVID-19 vaccine.PloS one · 2025Article
- Predictivity of the Prognostic Nutritional Index and Systemic Inflammation Index for All-Cause In-Hospital Mortality in Geriatric and Adult COVID-19 Inpatients.Journal of clinical medicine · 2024Article
- Association between emergency department disposition and mortality in patients with COVID-19 acute respiratory distress syndrome.Journal of the American College of Emergency Physicians open · 2024Article
- Serum transgelin is a novel prognostic biomarker for COVID-19 patients.Frontiers in immunology · 2024Article
- Impact of Surge Strain and Pandemic Progression on Prognostication by an Established COVID-19-Specific Severity Score.Critical care explorations · 2023Article
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7 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectivesEstimating 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.
setting99 emergency departments (EDs) across the USA.
participantsPatients ≥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.
resultsOf 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%).
conclusionsWe 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.
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