ArticleWorld journal of critical care medicine2025
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.
Article in World journal of critical care medicine, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundPrevious studies have reported the high predictive accuracy of 4C Mortality Score derived at hospital admission in coronavirus disease 2019 (COVID-19) patients. Very few studies have assessed it at intensive care unit (ICU) admission and compared it with the Acute Physiology and Chronic Health Evaluation (APACHE) II score. There are no studies comparing its accuracy with APACHE III score.
aimTo describe the characteristics and outcomes of patients admitted to ICU with COVID-19 infection and to compare the accuracy of 4C score and APACHE score in predicting mortality in these patients.
methodsWe conducted this retrospective cohort study using an electronic database in a tertiary ICU in Sydney. We included all adult patients (age > 16 years) admitted to ICU with COVID-19 infection over a 5-month period (July 1, 2021 to November 30, 2021). We collected the data on demographics, clinical characteristics, interventions and outcomes for all patients. We calculated the 4C Mortality Score for each patient using eight variables as described previously. We compared the predictive accuracy of 4C Mortality Score at hospital and ICU admission and APACHE II and III scores by area under the receiver operating characteristic curve (AUROC). We determined the optimal cut-off value for each of these scores using the 'nearest' method and its 95% confidence interval by bootstrapping.
resultsA total of 140 patients (62% males, mean age 56 ± 17 years, mean APACHE II score 13 ± 57) were included in the study. Nineteen (13.6%) of 140 patients died in the hospital. Compared to survivors, the non-survivors were older, males, had more comorbidities, higher rate of mechanical ventilation and vasopressor use. The AUROC for the 4C Mortality Score at hospital and ICU admission and APACHE II and II score was 0.75, 0.80. 0.75 and 0.79 respectively. The optimal cut-off value for these four scores was 9, 10, 14 and 56 respectively. The cut-point for all the scores had higher sensitivity than specificity.
conclusionThe 4C score at ICU admission had a higher accuracy in predicting mortality than the 4C score at hospital admission. The predictive accuracy was similar to that for APACHE III score. The 4C score at ICU admission needs to be validated in future studies.
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