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A team of UK researchers have developed an “easy-to-use” scoring system to help predict mortality risk in patients admitted to hospital with Covid-19.
Those behind the new system said it could be used by clinicians to inform treatment decisions and to stratify coronavirus patients into different management groups whilst in hospital.
“The score is likely to be a valuable tool for supporting decisions that allow prompt escalation of care”
The study, published in the BMJ this week, explored the use of the 4C (Coronavirus Clinical Characterisation Consortium) Mortality Score.
The group of researchers, on behalf of International Severe Acute Respiratory and Emerging Infection Consortium (ISARIC) investigators, said their new development “outperformed existing scores” but added that further testing was needed before it could be rolled out.
The 4C Mortality Score uses readily available data to categorise patients as being low, intermediate, high or very high risk of death.
To develop the model, data was collected from more than 35,000 adults who had Covid-19 and were admitted to 260 hospitals across England, Scotland and Wales between 6 February and 20 May 2020.
Information collected included age, sex, comorbidities, respiratory rate, blood oxygen concentration, level of consciousness, urea and C-reactive protein.
On the basis of these factors, patients would be assigned a score ranging from 0-21 and subsequently placed into one of the four risk groups.
According to the study, individuals with a score of 15 or more had a 62% chance of mortality compared with 1% for those with a score of three or less.
Those who had a 1% mortality rate and fell within the low risk group “might be suitable for management in the community”, study authors noted.
“This accurate and simple risk identification tool, will help detect at risk individuals quickly on arrival to hospital”
Dr Stephen Knight
Meanwhile, those put in the intermediate risk group, with a 10% mortality rate, “might be suitable for ward-level monitoring”, they added.
Individuals with a score of nine or more were at a high risk of death, “which could prompt aggressive treatment, including the initiation of steroids and early escalation to critical care if appropriate”.
Overall, researchers said their new system “compared favourably” to pre-existing models.
They described the score as “easy-to-use” and a “valid prediction tool for in-hospital mortality, accurately categorising patients as being at low, intermediate, high, or very high risk of death”.
Professor Calum Semple, chief investigator and professor in outbreak medicine and child health at the University of Liverpool, said with pressures set to increase over the winter, the scoring system would be a “valuable tool” in supporting staff to make decisions.
“This winter is likely to see great pressures on our health services, with staff being redeployed to less familiar acute care areas,” he said.
“In these difficult circumstances the 4C Mortality Score is likely to be a valuable tool for supporting decisions that allow prompt escalation of care to those most likely to benefit.”
Meanwhile, Dr Stephen Knight, co-lead author and NIHR clinical research fellow at the University of Edinburgh, said: “This accurate and simple risk identification tool, applicable across all groups within society, will help detect at risk individuals quickly on arrival to hospital.
“As importantly, we will be able to reassure and potentially treat at home those patients who fall within the low risk group.”
The study is titled: Risk stratification of patients admitted to hospital with covid-19 using the ISARIC WHO Clinical Characterisation Protocol: development and validation of the 4C Mortality Score.