Imperial College London

Peter Openshaw - Professor of Experimental Medicine

Faculty of MedicineNational Heart & Lung Institute

Senior Consul, Professor of Experimental Medicine



+44 (0)20 7594 3854p.openshaw Website CV




Ms Gale Lewis +44 (0)20 7594 0944




353Norfolk PlaceSt Mary's Campus






BibTex format

author = {Knight, SR and Ho, A and Pius, R and Buchan, I and Carson, G and Drake, TM and Dunning, J and Fairfield, CJ and Gamble, C and Green, CA and Gupta, R and Halpin, S and Hardwick, HE and Holden, KA and Horby, PW and Jackson, C and Mclean, KA and Merson, L and Nguyen-Van-Tam, JS and Norman, L and Noursadeghi, M and Olliaro, PL and Pritchard, MG and Russell, CD and Shaw, CA and Sheikh, A and Solomon, T and Sudlow, C and Swann, OV and Turtle, LCW and Openshaw, PJM and Baillie, JK and Semple, MG and Docherty, AB and Harrison, EM},
doi = {10.1136/bmj.m3339},
journal = {BMJ},
title = {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},
url = {},
volume = {370},
year = {2020}

RIS format (EndNote, RefMan)

AB - Objective To develop and validate a pragmatic risk score to predict mortality in patients admitted to hospital with coronavirus disease 2019 (covid-19).Design Prospective observational cohort study.Setting International Severe Acute Respiratory and emerging Infections Consortium (ISARIC) World Health Organization (WHO) Clinical Characterisation Protocol UK (CCP-UK) study (performed by the ISARIC Coronavirus Clinical Characterisation Consortium—ISARIC-4C) in 260 hospitals across England, Scotland, and Wales. Model training was performed on a cohort of patients recruited between 6 February and 20 May 2020, with validation conducted on a second cohort of patients recruited after model development between 21 May and 29 June 2020.Participants Adults (age >=18 years) admitted to hospital with covid-19 at least four weeks before final data extraction.Main outcome measure In-hospital mortality.Results 35 463 patients were included in the derivation dataset (mortality rate 32.2%) and 22 361 in the validation dataset (mortality rate 30.1%). The final 4C Mortality Score included eight variables readily available at initial hospital assessment: age, sex, number of comorbidities, respiratory rate, peripheral oxygen saturation, level of consciousness, urea level, and C reactive protein (score range 0-21 points). The 4C Score showed high discrimination for mortality (derivation cohort: area under the receiver operating characteristic curve 0.79, 95% confidence interval 0.78 to 0.79; validation cohort: 0.77, 0.76 to 0.77) with excellent calibration (validation: calibration-in-the-large=0, slope=1.0). Patients with a score of at least 15 (n=4158, 19%) had a 62% mortality (positive predictive value 62%) compared with 1% mortality for those with a score of 3 or less (n=1650, 7%; negative predictive value 99%). Discriminatory performance was higher than 15 pre-existing risk stratification scores (area under the receiver operating characteristic curve range 0.61-0.76), with sco
AU - Knight,SR
AU - Ho,A
AU - Pius,R
AU - Buchan,I
AU - Carson,G
AU - Drake,TM
AU - Dunning,J
AU - Fairfield,CJ
AU - Gamble,C
AU - Green,CA
AU - Gupta,R
AU - Halpin,S
AU - Hardwick,HE
AU - Holden,KA
AU - Horby,PW
AU - Jackson,C
AU - Mclean,KA
AU - Merson,L
AU - Nguyen-Van-Tam,JS
AU - Norman,L
AU - Noursadeghi,M
AU - Olliaro,PL
AU - Pritchard,MG
AU - Russell,CD
AU - Shaw,CA
AU - Sheikh,A
AU - Solomon,T
AU - Sudlow,C
AU - Swann,OV
AU - Turtle,LCW
AU - Openshaw,PJM
AU - Baillie,JK
AU - Semple,MG
AU - Docherty,AB
AU - Harrison,EM
DO - 10.1136/bmj.m3339
PY - 2020///
SN - 1759-2151
TI - 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
T2 - BMJ
UR -
UR -
UR -
VL - 370
ER -