New tool identifies COVID-19 patients risk of deterioration

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A new risk-stratification tool has been developed by researchers from the UK Coronavirus Clinical Characterisation Consortium and can accurately predict the likelihood of deterioration in hospitalised COVID-19 patients

Researchers, from the ISARIC4C, say the online tool could support clinicians’ decision making and has the potential to be incorporated into NHS Trusts’ Electronic Health Record System so that risk scores are automatically generated.

The tool, made freely available to NHS doctors, assesses 11 measurements routinely collected from patients including age, gender, and physical measurements along with some standard laboratory tests. It calculates a percentage risk of deterioration, known as the ‘4C Deterioration Score’.

Co-senior and corresponding author, Professor Mahdad Noursadeghi, UCL Infection & Immunity, said:

“Accurate risk-stratification at the point of admission to hospital will give doctors greater confidence about clinical decisions and planning ahead for the needs of individual patients.

“The addition of the new 4C deterioration score alongside the 4C mortality score will provide clinicians with an evidence-based measure to identify those who will need increased hospital support during their admission, even if they have a low risk of death.”

Tool development

The tool was developed using data from 74,944 patients with COVID-19 admitted to 260 hospitals across England, Scotland and Wales, between 6th February and 26th August 2020.

Using a multivariable logistic regression model, researchers tested the 11 measurements against the large group of patients that established how, and to what degree each of the measures affected the likelihood of deterioration.

First author Dr Rishi Gupta, UCL Institute of Global Health, said:

“The scale and wide geographical coverage of the ISARIC4C study across the country was critical to the development of this prediction tool. Our analysis provides very encouraging evidence that the 4C Deterioration tool is likely to be useful for clinicians across England, Scotland and Wales to support clinical decision-making.”

UK Coronavirus Clinical Characterisation Consortium (ISARIC4C)

ISARIC4C is a UK-wide consortium of NHS doctors and scientists from universities including:

  • UCL
  • Imperial College London
  • University of Liverpool
  • The University of Edinburgh
  • University of Oxford.

It was funded by UK Research and Innovation and Department of Health and Social Care through the National Institute for Health Research (NIHR).





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