Using ISARIC 4C mortality score to predict dynamic changes in mortality risk in COVID-19 patients during hospital admission

Crocker-Buqué, Tim; Myles, Jonathan; Brentnall, Adam R.; Gabe, Rhian; Duffy, Stephen W.; Williams, Sarah; Tiberi, Simon

doi:10.1371/journal.pone.0274158

Cited by 9 publications

(4 citation statements)

References 12 publications

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“…Several studies evaluate the dynamic use of the ISARIC 4C score at admission, using AUC to assess score discrimination on admission. In COVID-19 patients, Crocker-Buque et al [45] obtained an AUC of 0.71 (95% CI: 0.69-0.74), while Jones et al in a validation study, obtained an AUC of 0.77 (95 CI 0.79-0.87) at admission [45,46]. These AUCs appear to perform less well than the one obtained with our CZ-COVID-19 Score on admission.…”

Section: Discussioncontrasting

confidence: 52%

COVID-19: The Development and Validation of a New Mortality Risk Score

Zinna,

Pipitò,

Colomba

et al. 2024

JCM

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Background: The coronavirus disease 2019 (COVID-19) pandemic has found the whole world unprepared for its correct management. Italy was the first European country to experience the spread of the SARS-CoV-2 virus at the end of February 2020. As a result of hospital overcrowding, the quality of care delivered was not always optimal. A substantial number of patients admitted to non-ICU units could have been treated at home. It would have been extremely useful to have a score that, based on personal and clinical characteristics and simple blood tests, could have predicted with sufficient reliability the probability that a patient had or did not have a disease that could have led to their death. This study aims to develop a scoring system to identify which patients with COVID-19 are at high mortality risk upon hospital admission, to expedite and enhance clinical decision making. Methods: A retrospective analysis was performed to develop a multivariable prognostic prediction model. Results: Derivation and external validation cohorts were obtained from two Italian University Hospital databases, including 388 (10.31% deceased) and 1357 (7.68% deceased) patients with confirmed COVID-19, respectively. A multivariable logistic model was used to select seven variables associated with in-hospital death (age, baseline oxygen saturation, hemoglobin value, white blood cell count, percentage of neutrophils, platelet count, and creatinine value). Calibration and discrimination were satisfactory with a cumulative AUC for prediction mortality of 0.924 (95% CI: 0.893–0.944) in derivation cohorts and 0.808 (95% CI: 0.886–0.828) in external validation cohorts. The risk score obtained was compared with the ISARIC 4C Mortality Score, and with all the other most important scores considered so far, to evaluate the risk of death of patients with COVID-19. It performed better than all the above scores to evaluate the predictability of dying. Its sensitivity, specificity, and AUC were higher than the other COVID-19 scoring systems when the latter were calculated for the 388 patients in our derivation cohort. Conclusions: In conclusion, the CZ-COVID-19 Score may help all physicians by identifying those COVID-19 patients who require more attention to provide better therapeutic regimens or, on the contrary, by identifying those patients for whom hospitalization is not necessary and who could therefore be sent home without overcrowding healthcare facilities. We developed and validated a new risk score based on seven variables for upon-hospital admission of COVID-19 patients. It is very simple to calculate and performs better than all the other similar scores to evaluate the predictability of dying.

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Section: Discussioncontrasting

confidence: 52%

COVID-19: The Development and Validation of a New Mortality Risk Score

Zinna,

Pipitò,

Colomba

et al. 2024

JCM

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“…This scoring system is derived from a comprehensive population cohort study conducted at the national level in the United Kingdom. 21 Understanding the clinical course of COVID-19 is crucial until a viable vaccination becomes widely accessible, due to the lack of specific therapies and the tremendous health and economic impact of the pandemic. 1,22 In this situation, deficient vitamin D is a modifiable risk factor due to its safety and affordability.…”

Section: Resultsmentioning

confidence: 99%

Impact of vitamin D deficiency in relation to the clinical outcomes of hospitalized COVID-19 patients

et al. 2023

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Background: Vitamin D deficiency is an emerging public health problem that affects more than one billion people worldwide. Vitamin D has been shown to be effective in preventing and reducing the severity of viral respiratory diseases, including influenza. However, the role of vitamin D in COVID-19 infection remains controversial. This study aimed to analyze the impact of vitamin D deficiency on the clinical outcome of hospitalized COVID-19 patients. Methods: A prospective cohort study was conducted among hospitalized COVID-19 patients at two COVID-19 referral hospitals in Indonesia from October 2021 until February 2022. Results: The median serum 25(OH)D level in 191 hospitalized COVID-19 patients was 13.6 [IQR=10.98] ng/mL. The serum 25(OH)D levels were significantly lower among COVID-19 patients with vitamin D deficiency who had cardiovascular disease (p-value=0.04), the use of a ventilator (p-value=0.004), more severe COVID-19 cases (p-value=0.047), and mortality (p-value=0.002). Furthermore, serum 25(OH)D levels were significantly different between patients with mild and severe COVID-19 cases (p-value <0.001). Serum 25(OH)D levels in mild and moderate COVID-19 cases were significantly different (p-value=0.002). Lower serum 25(OH)D levels were significantly associated with an increased number of comorbidities (p-value=0.03), the severity of COVID-19 (p-value=0.002), and the use of mechanical ventilation (p-value=0.032). Mortality was found in 7.3% of patients with deficient vitamin D levels. However, patients with either sufficient or insufficient vitamin D levels did not develop mortality. Conclusions: COVID-19 patients with vitamin D deficiency were significantly associated with having cardiovascular disease, mortality, more severe COVID-19 cases, and the used of mechanical ventilation. Lower serum 25(OH)D levels were associated with an increased number of comorbidities, COVID-19 severity, and the use of mechanical-ventilation. Thus, we suggest hospitalized COVID-19 patients to reach a sufficient vitamin D status to improve the clinical outcome of the disease.

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“…Another study from Saudi Arabia found that the ISARIC 4C Mortality Score is an excellent tool to predict mortality in critically ill COVID-19 patients with an AUC of 0.81; the sensitivity was 70.5% and the specificity 73.97% with a cutoff value of >9 [ 22 ]. In addition, Crocker-Buque et al support using the ISARIC 4C Mortality Score for triaging COVID-19 patients at the time of admission and as a dynamic tool that provides accurate mortality risk information at any time during the hospitalization of COVID-19 patients [ 34 ].…”

Section: Discussionmentioning

confidence: 99%