TY - JOUR 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 - http://dx.doi.org/10.1136/bmj.m3339 UR - https://www.bmj.com/content/370/bmj.m3339 UR - http://hdl.handle.net/10044/1/82920 VL - 370 ER -