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Development and validation of the ISARIC 4C Deterioration model for adults hospitalised with COVID-19: a prospective cohort study

BACKGROUND: Prognostic models to predict the risk of clinical deterioration in acute COVID-19 cases are urgently required to inform clinical management decisions. METHODS: We developed and validated a multivariable logistic regression model for in-hospital clinical deterioration (defined as any requ...

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Autores principales: Gupta, Rishi K, Harrison, Ewen M, Ho, Antonia, Docherty, Annemarie B, Knight, Stephen R, van Smeden, Maarten, Abubakar, Ibrahim, Lipman, Marc, Quartagno, Matteo, Pius, Riinu, Buchan, Iain, Carson, Gail, Drake, Thomas M, Dunning, Jake, Fairfield, Cameron J, Gamble, Carrol, Green, Christopher A, Halpin, Sophie, Hardwick, Hayley E, Holden, Karl A, Horby, Peter W, Jackson, Clare, Mclean, Kenneth A, Merson, Laura, Nguyen-Van-Tam, Jonathan S, Norman, Lisa, Olliaro, Piero L, Pritchard, Mark G, Russell, Clark D, Scott-Brown, James, Shaw, Catherine A, Sheikh, Aziz, Solomon, Tom, Sudlow, Cathie, Swann, Olivia V, Turtle, Lance, Openshaw, Peter J M, Baillie, J Kenneth, Semple, Malcolm G, Noursadeghi, Mahdad
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7832571/
https://www.ncbi.nlm.nih.gov/pubmed/33444539
http://dx.doi.org/10.1016/S2213-2600(20)30559-2
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author Gupta, Rishi K
Harrison, Ewen M
Ho, Antonia
Docherty, Annemarie B
Knight, Stephen R
van Smeden, Maarten
Abubakar, Ibrahim
Lipman, Marc
Quartagno, Matteo
Pius, Riinu
Buchan, Iain
Carson, Gail
Drake, Thomas M
Dunning, Jake
Fairfield, Cameron J
Gamble, Carrol
Green, Christopher A
Halpin, Sophie
Hardwick, Hayley E
Holden, Karl A
Horby, Peter W
Jackson, Clare
Mclean, Kenneth A
Merson, Laura
Nguyen-Van-Tam, Jonathan S
Norman, Lisa
Olliaro, Piero L
Pritchard, Mark G
Russell, Clark D
Scott-Brown, James
Shaw, Catherine A
Sheikh, Aziz
Solomon, Tom
Sudlow, Cathie
Swann, Olivia V
Turtle, Lance
Openshaw, Peter J M
Baillie, J Kenneth
Semple, Malcolm G
Noursadeghi, Mahdad
author_facet Gupta, Rishi K
Harrison, Ewen M
Ho, Antonia
Docherty, Annemarie B
Knight, Stephen R
van Smeden, Maarten
Abubakar, Ibrahim
Lipman, Marc
Quartagno, Matteo
Pius, Riinu
Buchan, Iain
Carson, Gail
Drake, Thomas M
Dunning, Jake
Fairfield, Cameron J
Gamble, Carrol
Green, Christopher A
Halpin, Sophie
Hardwick, Hayley E
Holden, Karl A
Horby, Peter W
Jackson, Clare
Mclean, Kenneth A
Merson, Laura
Nguyen-Van-Tam, Jonathan S
Norman, Lisa
Olliaro, Piero L
Pritchard, Mark G
Russell, Clark D
Scott-Brown, James
Shaw, Catherine A
Sheikh, Aziz
Solomon, Tom
Sudlow, Cathie
Swann, Olivia V
Turtle, Lance
Openshaw, Peter J M
Baillie, J Kenneth
Semple, Malcolm G
Noursadeghi, Mahdad
author_sort Gupta, Rishi K
collection PubMed
description BACKGROUND: Prognostic models to predict the risk of clinical deterioration in acute COVID-19 cases are urgently required to inform clinical management decisions. METHODS: We developed and validated a multivariable logistic regression model for in-hospital clinical deterioration (defined as any requirement of ventilatory support or critical care, or death) among consecutively hospitalised adults with highly suspected or confirmed COVID-19 who were prospectively recruited to the International Severe Acute Respiratory and Emerging Infections Consortium Coronavirus Clinical Characterisation Consortium (ISARIC4C) study across 260 hospitals in England, Scotland, and Wales. Candidate predictors that were specified a priori were considered for inclusion in the model on the basis of previous prognostic scores and emerging literature describing routinely measured biomarkers associated with COVID-19 prognosis. We used internal–external cross-validation to evaluate discrimination, calibration, and clinical utility across eight National Health Service (NHS) regions in the development cohort. We further validated the final model in held-out data from an additional NHS region (London). FINDINGS: 74 944 participants (recruited between Feb 6 and Aug 26, 2020) were included, of whom 31 924 (43·2%) of 73 948 with available outcomes met the composite clinical deterioration outcome. In internal–external cross-validation in the development cohort of 66 705 participants, the selected model (comprising 11 predictors routinely measured at the point of hospital admission) showed consistent discrimination, calibration, and clinical utility across all eight NHS regions. In held-out data from London (n=8239), the model showed a similarly consistent performance (C-statistic 0·77 [95% CI 0·76 to 0·78]; calibration-in-the-large 0·00 [–0·05 to 0·05]); calibration slope 0·96 [0·91 to 1·01]), and greater net benefit than any other reproducible prognostic model. INTERPRETATION: The 4C Deterioration model has strong potential for clinical utility and generalisability to predict clinical deterioration and inform decision making among adults hospitalised with COVID-19. FUNDING: National Institute for Health Research (NIHR), UK Medical Research Council, Wellcome Trust, Department for International Development, Bill & Melinda Gates Foundation, EU Platform for European Preparedness Against (Re-)emerging Epidemics, NIHR Health Protection Research Unit (HPRU) in Emerging and Zoonotic Infections at University of Liverpool, NIHR HPRU in Respiratory Infections at Imperial College London.
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spelling pubmed-78325712021-01-26 Development and validation of the ISARIC 4C Deterioration model for adults hospitalised with COVID-19: a prospective cohort study Gupta, Rishi K Harrison, Ewen M Ho, Antonia Docherty, Annemarie B Knight, Stephen R van Smeden, Maarten Abubakar, Ibrahim Lipman, Marc Quartagno, Matteo Pius, Riinu Buchan, Iain Carson, Gail Drake, Thomas M Dunning, Jake Fairfield, Cameron J Gamble, Carrol Green, Christopher A Halpin, Sophie Hardwick, Hayley E Holden, Karl A Horby, Peter W Jackson, Clare Mclean, Kenneth A Merson, Laura Nguyen-Van-Tam, Jonathan S Norman, Lisa Olliaro, Piero L Pritchard, Mark G Russell, Clark D Scott-Brown, James Shaw, Catherine A Sheikh, Aziz Solomon, Tom Sudlow, Cathie Swann, Olivia V Turtle, Lance Openshaw, Peter J M Baillie, J Kenneth Semple, Malcolm G Noursadeghi, Mahdad Lancet Respir Med Articles BACKGROUND: Prognostic models to predict the risk of clinical deterioration in acute COVID-19 cases are urgently required to inform clinical management decisions. METHODS: We developed and validated a multivariable logistic regression model for in-hospital clinical deterioration (defined as any requirement of ventilatory support or critical care, or death) among consecutively hospitalised adults with highly suspected or confirmed COVID-19 who were prospectively recruited to the International Severe Acute Respiratory and Emerging Infections Consortium Coronavirus Clinical Characterisation Consortium (ISARIC4C) study across 260 hospitals in England, Scotland, and Wales. Candidate predictors that were specified a priori were considered for inclusion in the model on the basis of previous prognostic scores and emerging literature describing routinely measured biomarkers associated with COVID-19 prognosis. We used internal–external cross-validation to evaluate discrimination, calibration, and clinical utility across eight National Health Service (NHS) regions in the development cohort. We further validated the final model in held-out data from an additional NHS region (London). FINDINGS: 74 944 participants (recruited between Feb 6 and Aug 26, 2020) were included, of whom 31 924 (43·2%) of 73 948 with available outcomes met the composite clinical deterioration outcome. In internal–external cross-validation in the development cohort of 66 705 participants, the selected model (comprising 11 predictors routinely measured at the point of hospital admission) showed consistent discrimination, calibration, and clinical utility across all eight NHS regions. In held-out data from London (n=8239), the model showed a similarly consistent performance (C-statistic 0·77 [95% CI 0·76 to 0·78]; calibration-in-the-large 0·00 [–0·05 to 0·05]); calibration slope 0·96 [0·91 to 1·01]), and greater net benefit than any other reproducible prognostic model. INTERPRETATION: The 4C Deterioration model has strong potential for clinical utility and generalisability to predict clinical deterioration and inform decision making among adults hospitalised with COVID-19. FUNDING: National Institute for Health Research (NIHR), UK Medical Research Council, Wellcome Trust, Department for International Development, Bill & Melinda Gates Foundation, EU Platform for European Preparedness Against (Re-)emerging Epidemics, NIHR Health Protection Research Unit (HPRU) in Emerging and Zoonotic Infections at University of Liverpool, NIHR HPRU in Respiratory Infections at Imperial College London. Elsevier 2021-04 /pmc/articles/PMC7832571/ /pubmed/33444539 http://dx.doi.org/10.1016/S2213-2600(20)30559-2 Text en © 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license http://creativecommons.org/licenses/by/4.0/ This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Articles
Gupta, Rishi K
Harrison, Ewen M
Ho, Antonia
Docherty, Annemarie B
Knight, Stephen R
van Smeden, Maarten
Abubakar, Ibrahim
Lipman, Marc
Quartagno, Matteo
Pius, Riinu
Buchan, Iain
Carson, Gail
Drake, Thomas M
Dunning, Jake
Fairfield, Cameron J
Gamble, Carrol
Green, Christopher A
Halpin, Sophie
Hardwick, Hayley E
Holden, Karl A
Horby, Peter W
Jackson, Clare
Mclean, Kenneth A
Merson, Laura
Nguyen-Van-Tam, Jonathan S
Norman, Lisa
Olliaro, Piero L
Pritchard, Mark G
Russell, Clark D
Scott-Brown, James
Shaw, Catherine A
Sheikh, Aziz
Solomon, Tom
Sudlow, Cathie
Swann, Olivia V
Turtle, Lance
Openshaw, Peter J M
Baillie, J Kenneth
Semple, Malcolm G
Noursadeghi, Mahdad
Development and validation of the ISARIC 4C Deterioration model for adults hospitalised with COVID-19: a prospective cohort study
title Development and validation of the ISARIC 4C Deterioration model for adults hospitalised with COVID-19: a prospective cohort study
title_full Development and validation of the ISARIC 4C Deterioration model for adults hospitalised with COVID-19: a prospective cohort study
title_fullStr Development and validation of the ISARIC 4C Deterioration model for adults hospitalised with COVID-19: a prospective cohort study
title_full_unstemmed Development and validation of the ISARIC 4C Deterioration model for adults hospitalised with COVID-19: a prospective cohort study
title_short Development and validation of the ISARIC 4C Deterioration model for adults hospitalised with COVID-19: a prospective cohort study
title_sort development and validation of the isaric 4c deterioration model for adults hospitalised with covid-19: a prospective cohort study
topic Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7832571/
https://www.ncbi.nlm.nih.gov/pubmed/33444539
http://dx.doi.org/10.1016/S2213-2600(20)30559-2
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