Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St W, Hamilton, ON, L8S 4L8, Canada.
Waterloo Regional Campus, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Canada.
Sci Rep. 2021 Sep 20;11(1):18638. doi: 10.1038/s41598-021-97332-1.
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.
风险预测评分是支持冠状病毒病（COVID-19）患者临床决策的重要工具。本文的目的是验证最初在英国开发的 4C 死亡率评分在加拿大人群中的有效性，并研究其随时间的表现。我们在安大略省南部 Kitchener-Waterloo 和 Hamilton 地区的 COVID-19 阳性住院患者登记处进行了一项外部验证研究。我们使用接受者操作特征曲线下面积（AUC）评估 4C 评分预测院内死亡率的有效性，并通过自举法计算 95%置信区间。该研究纳入了 959 名患者，其中 224 名（23.4%）在院内死亡。中位年龄为 72 岁，524 名患者（55%）为男性。4C 评分的 AUC 为 0.77，95%置信区间为 0.79-0.87。在预先定义的风险组中，总体死亡率分别为 0%（低危）、8.0%（中危）、27.2%（高危）和 54.2%（极高危）。AUC 的第 1、2 和 3 波值分别为 0.81（0.76，0.86）、0.74（0.69，0.80）和 0.76（0.69，0.83）。4C 评分是一种预测加拿大医院 COVID-19 死亡率的有效工具，可用于优先考虑死亡风险最高的患者的护理和资源。
