A new easy-to-use score for predicting risk of death in adult patients admitted to hospital with COVID-19 has been developed by the UK Coronavirus Clinical Characterisation Consortium (4C). A study published by the BMJ found that the 4C Mortality Score outperformed existing prognostic scores.
The 4C Mortality Score uses readily available data to accurately categorise patients as being at low, intermediate, high or very high risk of death. Routine data from 35,463 adults (median age, 74 years) with COVID-19 who were admitted to 260 hospitals across England, Scotland and Wales between 6 February 2020 and 20 May 2020 were collected.
Risk cut-off values were defined by the total point score (range 0-21) for an individual which represented a low (<2% mortality rate), intermediate (2%-14.9%) or high-risk (≥15% or more) groups, similar to commonly used pneumonia risk scores.
Patients with a score of ≥15 had 62 per cent mortality compared with 1 per cent mortality for those with a score of ≤3, suggesting that patients with a 4C Mortality Score within the low-risk threshold might be suitable for management in the community, say the researchers.
Patients with a score of ≥9 were at high risk of death (~40%), which might prompt aggressive treatment.
To validate the model, the researchers tested it on 22,361 patients admitted to the same hospitals between 21 May 2020 and 29 June 2020. They found similar score performance, even after taking account of other potentially important factors.
When comparing the 4C Morality Score to existing risk scores, it demonstrated high discrimination for mortality. It compared favourably to 15 pre-existing and more complex models.
