Bruno Karima E, Mussi Henrique, Bruno Amanda E, Rodrigues Juliana B, Rezende Manuella, Cortes Victor C, Gismondi Ronaldo A
Medicina Clinica, Hospital Universitário Antônio Pedro (Ebserh/Universidade Federal Fluminense), Niteroi, BRA.
Cureus. 2025 Jan 2;17(1):e76811. doi: 10.7759/cureus.76811. eCollection 2025 Jan.
Background The 4C (Coronavirus Clinical Characterization Consortium) Mortality Score has demonstrated good discrimination in COVID-19 but has not been widely validated in Brazil. The 4C Mortality Score is a clinical tool developed during the COVID-19 pandemic to predict in-hospital mortality for patients admitted with COVID-19. It was derived from a large dataset of hospitalized patients in the United Kingdom and provides a simple yet effective way to stratify patients based on their risk of death. Objective This study aimed to determine the accuracy of the 4C Mortality Score in patients admitted with COVID-19 in a university teaching hospital. Methods The study was observational, longitudinal, and retrospective, conducted in a 180-bed university teaching hospital in Rio de Janeiro, Brazil. We included all patients admitted with COVID-19 and followed them until discharge. The 4C Mortality Score was calculated based on age, sex, Charlson index, respiratory rate, peripheral oxygen saturation (room air), Glasgow Coma Scale, serum urea, and C-reactive protein (CRP) level. The primary outcome was mortality. Results We included 208 participants, with a median age of 63 years. Among them, 111 (53%) were male; 52 (25%) had cardiovascular disease, and 83 (39%) had cancer. Mortality was 39.9%. Independent predictors of mortality were age, hemoglobin, CRP, mechanical ventilation, and the need for vasopressors. The 4C Mortality Score's area under the receiver operating characteristic curve (AUC-ROC) was 89.9%. Conclusion The 4C Mortality Score demonstrated excellent discrimination in a teaching hospital population.
4C（冠状病毒临床特征联盟）死亡率评分在新型冠状病毒肺炎（COVID-19）中已显示出良好的区分能力，但在巴西尚未得到广泛验证。4C死亡率评分是在COVID-19大流行期间开发的一种临床工具，用于预测因COVID-19入院患者的院内死亡率。它源自英国大量住院患者的数据集，并提供了一种基于患者死亡风险对其进行分层的简单而有效的方法。
本研究旨在确定4C死亡率评分在一家大学教学医院中因COVID-19入院患者中的准确性。
本研究为观察性、纵向和回顾性研究，在巴西里约热内卢一家拥有180张床位的大学教学医院进行。我们纳入了所有因COVID-19入院的患者，并对其进行随访直至出院。4C死亡率评分基于年龄、性别、查尔森指数、呼吸频率、外周血氧饱和度（室内空气）、格拉斯哥昏迷量表、血清尿素和C反应蛋白（CRP）水平进行计算。主要结局为死亡率。
我们纳入了208名参与者，中位年龄为63岁。其中，111名（53%）为男性；52名（25%）患有心血管疾病，83名（39%）患有癌症。死亡率为39.9%。死亡率的独立预测因素为年龄、血红蛋白、CRP、机械通气和血管升压药的使用需求。4C死亡率评分的受试者工作特征曲线下面积（AUC-ROC）为89.9%。
4C死亡率评分在教学医院人群中显示出优异的区分能力。
