SARS-CoV-2 (shown here in an electron microscope picture). Credit: National Institute for Allergy and Infectious Diseases, NIH

Researchers at the UK’s Coronavirus Clinical Characterization Consortium (known as ISARIC4C) have developed a new risk stratification tool that can accurately predict the likelihood of deterioration in adults hospitalized with COVID-19.

Researchers say the online tool, available for free to NHS doctors starting today, could aid clinicians in decision-making and could help improve patient outcomes and ultimately save lives.

The tool rates 11 measurements routinely collected from patients, including age, gender, and physical measurements (such as oxygen levels), along with some standard laboratory tests, and calculates a percentage risk of deterioration known as the 4C Deterioration Score.

This innovation, published in The Lancet Respiratory Medicine, builds on previous work by the consortium to develop the 4C Mortality Score to predict the percent risk of death from COVID-19 after hospitalization. The ‘4C Mortality Score’ is already recommended by NHS England as a guide for antiviral treatments (remdesivir).

Doctors now see the ‘4C Deterioration Score’ and the ‘4C Mortality Score’ simultaneously with the same tool

Co-Senior and Corresponding Author, Professor Mahdad Noursadeghi (UCL Infection & Immunity) said, “Accurate risk stratification at the time of hospitalization will give clinicians greater confidence in clinical decisions and predictive planning for individual patient needs.

“The addition of the new 4C deterioration score alongside the 4C mortality score provides clinicians with an evidence-based tool to identify those in need of increased hospital support during their admission, even if they are at low risk of death.”

The tool was developed using data from 74,944 people with COVID-19 enrolled in 260 hospitals in England, Scotland and Wales between February 6 and August 26, 2020.

Using a multivariable logistic regression model (which uses multiple measures to predict an outcome), the researchers tested the 11 measures (age / gender / physical measures / laboratory tests) on the large patient cohort to see how and to what extent they each did to be assessed the measures influenced the likelihood of deterioration.

Additionally, the researchers rated how well the tool worked in nine NHS regions and found that it performed similarly well in each region, suggesting that it is likely to be useful across the NHS. Importantly, the new risk score performed superior to previous risk scores across the NHS.

The first author Dr. Rishi Gupta (UCL Institute for Global Health) said, “The scope and broad geographic coverage of the ISARIC4C study across the country were critical to the development of this predictive tool. Our analysis provides very encouraging evidence that the 4C deterioration tool is likely to be useful to clinicians across England, Scotland and Wales to aid clinical decision-making. “

The tool may be integrated with the NHS Trusts’ electronic health record system, which manages all patient care so that risk assessments are automatically generated for patients.

The researchers suggest that the tool could be used for risk stratification in other countries as well, but it should be evaluated first to test its accuracy in these settings.

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More information:
Rishi K. Gupta, Peter Openshaw, J. Kenneth Baillie, Malcolm Semple, Mahdad Noursadeghi on behalf of ISARIC4C investigators: “Development and validation of the ISARIC 4C deterioration model for adults hospitalized with COVID-19: a prospective cohort study “Lancet Respiratory Medicine, DOI: 10.1016 / S2213-2600 (20) 30559-2

ISARIC4C website:

Provided by University College London

Quote: COVID-19: The online tool identifies patients at highest risk of worsening (2021, January 8), who were found on January 9, 2021 from tool-patients-highest.html

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