_id

683a1646c782e11e38d1b2f9

id

10338

title

4C Mortality Score for COVID-19

full_title

4C Mortality Score for COVID-19

short_title

4C Mortality Score for COVID-19

med_description

Predicts in-hospital mortality in patients admitted with COVID-19.

short_description

In-hospital COVID-19 mortality.

slug

4c-mortality-score-covid-19

description

The 4C Mortality Score for COVID-19 predicts mortality in patients admitted to hospital with COVID-19.

keywords

4C Mortality Score for COVID-19, 4C, 4C mortality, 4C covid-19, 4c covid, 4c covid mortality, covid mortality, covid score, covid mortality score, 4c covid-19 mortality, covid-19 mortality, covid-19 mortality score, coronavirus mortality score, coronavirus mortality, 4c coronavirus mortality, 4c coronavirus, coronavirus, covid-19, covid

complaint

[ "Chest Pain", "Cough", "Fever", "Shortness of Breath" ]

formula

*Comorbidities include chronic cardiac disease, chronic respiratory disease (excluding asthma), chronic renal disease (estimated glomerular filtration rate ≤30), mild to severe liver disease, dementia, chronic neurological conditions, connective tissue disease, diabetes mellitus (diet, tablet, or insulin controlled), HIV or AIDS, and malignancy.

evidence

The 4C Mortality Score was derived from a prospective observational cohort study based upon positively tested COVID-19 patients admitted to 260 hospitals in England, Scotland and Wales. The score includes eight variables consisting of age, sex, number of comorbidities, respiratory rate, peripheral oxygen saturation, Glasgow coma scale score, urea level, and C-reactive protein. The score, ranging from 0-21, predicts in-hospital mortality from low risk to very high risk. The score, when compared against existing scores for CAP and COVID-19, performed better in predicting in-hospital mortality in the validation cohort.

The score performed well in the internal validation of the study along with external validation studies. The score is limited to determining in-patient hospital mortality and is not designed to be applicable to the outpatient setting. Overall generalizability of the score needs to be further investigated as it was derived and validated in a primarily homogeneous ethnic and age cohort.

measurements

[]

information

Interpretation:

refrences

{ "Clinical Practice Guidelines": [], "Manufacturer Website": [], "Original/Primary Reference": [ { "href": "https://www.bmj.com/content/370/bmj.m3339", "text": "Knight SR, Ho A, Pius R, et al. Risk stratification of patients admitted Kto hospital with covid-19 using the ISARIC WHO Clinical Characterisation Protocol: development and validation of the 4C Mortality Score. BMJ. 2020;370:m3339." } ], "Other References": [], "Outcomes": [], "Validation": [ { "href": "https://www.bmj.com/content/370/bmj.m3339", "text": "Knight SR, Ho A, Pius R, et al. Risk stratification of patients admitted Kto hospital with covid-19 using the ISARIC WHO Clinical Characterisation Protocol: development and validation of the 4C Mortality Score. BMJ. 2020;370:m3339." }, { "href": "https://www.nature.com/articles/s41598-021-97332-1", "text": "Jones A, Pitre T, Junek M, et al. External validation of the 4C mortality score among COVID-19 patients admitted to hospital in Ontario, Canada: a retrospective study. Sci Rep. 2021;11(1):18638." } ], "Validations": [] }

pearls

• Designed specifically for hospitalized COVID-19 patients. This may not apply to patients seen in the outpatient setting.
• Requires eight specific predictors of mortality, not all of which may be immediately available in all settings (e.g. CRP).  
• Patient population in the study had a median age of 73 years old, 82% white, with an overall mortality of 32.2%. All patients were from England, Scotland, and Wales. Consider when applying this to your patient population

usecase

Apply to risk stratify patients who are admitted with COVID-19.

reasons

Risk stratification of admitted COVID-19 patients to aid in determining mortality risk, decision for level of care, and prognostication.

next_advice

• Threshold for level of care may change during resource-limited situations such as the current COVID-19 outbreak.
• Apply to admitted patients and not designed to influence the decision to discharge at initial presentation.

next_actions

When applying to a hospitalized COVID-19 patient, score may be used in conjunction with clinical suspicion to determine mortality risk and appropriate level of care.

next_management

• Low risk - May be suitable for outpatient management
• Intermediate risk - May be suitable for general inpatient treatment
• High risk - May require aggressive treatment and higher level of monitoring

diseases

[ "Coronavirus", "COVID-19" ]

input_schema

[ { "conditionality": "", "default": 0, "label_en": "<p>Age, years</p>", "name": "one", "optional": false, "options": [ { "label": "<50", "value": 0 }, { "label": "50-59", "value": 2 }, { "label": "60-69", "value": 4 }, { "label": "70-79", "value": 6 }, { "label": "≥80", "value": 7 } ], "show_points": true, "tips_en": "", "type": "radio" }, { "conditionality": "", "default": 0, "label_en": "<p>Sex at birth</p>", "name": "two", "optional": false, "options": [ { "label": "Female", "value": 0 }, { "label": "Male", "value": 1 } ], "show_points": true, "tips_en": "", "type": "radio" }, { "conditionality": "", "default": 0, "label_en": "<p>Number of comorbidities</p>", "name": "three", "optional": false, "options": [ { "label": "0", "value": 0 }, { "label": "1", "value": 1 }, { "label": "≥2", "value": 2 } ], "show_points": true, "tips_en": "Comorbidities include chronic cardiac disease, chronic respiratory disease (excluding asthma), chronic renal disease (estimated glomerular filtration rate ≤30), mild to severe liver disease, dementia, chronic neurological conditions, connective tissue disease, diabetes mellitus (diet, tablet, or insulin controlled), HIV or AIDS, and malignancy.", "type": "radio" }, { "conditionality": "", "default": 0, "label_en": "<p>Respiratory rate, breaths/min</p>", "name": "four", "optional": false, "options": [ { "label": "<20", "value": 0 }, { "label": "20-29", "value": 1 }, { "label": "≥30", "value": 2 } ], "show_points": true, "tips_en": "", "type": "radio" }, { "conditionality": "", "default": 0, "label_en": "<p>Peripheral oxygen saturation on room air</p>", "name": "five", "optional": false, "options": [ { "label": "≥92%", "value": 0 }, { "label": "<92%", "value": 2 } ], "show_points": true, "tips_en": "", "type": "radio" }, { "conditionality": "", "default": 0, "label_en": "<p><calculator id=\"64\">Glasgow Coma Scale</calculator></p>", "name": "six", "optional": false, "options": [ { "label": "15", "value": 0 }, { "label": "<15", "value": 2 } ], "show_points": true, "tips_en": "", "type": "radio" }, { "conditionality": "", "default": 0, "label_en": "<p>Select measurement available</p>", "name": "avail", "optional": false, "options": [ { "label": "BUN", "value": 1 }, { "label": "Urea", "value": 0 } ], "show_points": false, "tips_en": "", "type": "toggle" }, { "conditionality": "avail==0", "default": 0, "label_en": "<p>Urea</p>", "name": "seven", "optional": false, "options": [ { "label": "<7 mmol/L (<42 mg/dL)", "value": 0 }, { "label": "≥7 to ≤14 mmol/L (≥42mg/dL to ≤84 mg/dL)", "value": 1 }, { "label": ">14 mmol/L (>84 mg/dL)", "value": 3 } ], "show_points": true, "tips_en": "", "type": "radio" }, { "conditionality": "avail==1", "default": 0, "label_en": "<p>BUN</p>", "name": "bun", "optional": false, "options": [ { "label": "<19.6 mg/dL", "value": 0 }, { "label": "≥19.6 to ≤39.2 mg/dL", "value": 1 }, { "label": ">39.2 mg/dL", "value": 3 } ], "show_points": true, "tips_en": "", "type": "radio" }, { "conditionality": "", "default": 0, "label_en": "<p>C-reactive protein</p>", "name": "eight", "optional": false, "options": [ { "label": "<50 mg/L (<5 mg/dL)", "value": 0 }, { "label": "50-99 mg/L (5-9.9 mg/dL)", "value": 1 }, { "label": "≥100 mg/L (≥10 mg/dL)", "value": 2 } ], "show_points": true, "tips_en": "", "type": "radio" } ]

instructions

Use with admitted patients diagnosed with COVID-19.

published

2022-04-21T20:28:48.399Z

purpose

[ "Prognosis" ]

search_terms

[ "4C Mortality Score for COVID-19, 4C, 4C mortality, 4C covid-19, 4c covid, 4c covid mortality, covid mortality, covid score, covid mortality score, 4c covid-19 mortality, covid-19 mortality, covid-19 mortality score, coronavirus mortality score, coronavirus mortality, 4c coronavirus mortality, 4c coronavirus, coronavirus, covid-19, covid" ]

seo

{ "keywords_en": "4C Mortality Score for COVID-19, 4C, 4C mortality, 4C covid-19, 4c covid, 4c covid mortality, covid mortality, covid score, covid mortality score, 4c covid-19 mortality, covid-19 mortality, covid-19 mortality score, coronavirus mortality score, coronavirus mortality, 4c coronavirus mortality, 4c coronavirus, coronavirus, covid-19, covid", "meta_description_en": "The 4C Mortality Score for COVID-19 predicts mortality in patients admitted to hospital with COVID-19." }

specialty

[ "Critical Care", "Emergency Medicine", "Hospitalist Medicine", "Infectious Disease", "Internal Medicine", "Pulmonology" ]

departments

[ "Respiratory" ]

tags

[]

version_number

1

versions

[]

related

[ { "calcId": 10354, "short_title_en": "CHOSEN Risk Score", "slug": "covid-home-safely-now-chosen-risk-score-covid-19" }, { "calcId": 10279, "short_title_en": "MuLBSTA Score", "slug": "mulbsta-score-viral-pneumonia-mortality" }, { "calcId": 10371, "short_title_en": "CIRC", "slug": "covid-19-inpatient-risk-calculator-circ" } ]

ismed

false

section

[ "whenToUseViewed", "pearlsPitfallsViewed", "whyUseViewed", "nextStepsViewed", "evidenceViewed" ]

cleaned_departments

[ "pulmonology" ]

cleaned_use

[ "Apply to risk stratify patients who are admitted with COVID-19." ]

pub

false