SHM Converge Scientific Abstract ePoster Gallery-External Validation of the Covid-19 4c Mortality Score in a United States Cohort

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This study tested whether the COVID-19 4C Mortality Score, a widely used risk model, accurately predicts in-hospital death in a U.S. patient population. Although the score had already been validated in several countries, it had not previously been studied in the United States.<br /><br />Researchers reviewed 426 adults admitted to Thomas Jefferson University Hospital in Philadelphia between March 1 and June 6, 2020, all with PCR-confirmed SARS-CoV-2 infection. Clinical comorbidities were abstracted from electronic health records using two independent manual chart reviews with adjudication of disagreements. Because missing data were minimal (<1.4%), the team used multiple imputation to create 20 datasets and then evaluated model performance using receiver operating characteristic curves and area under the curve (AUC) analysis. The pooled AUC was calculated using Rubin’s rules.<br /><br />The 4C Mortality Score performed well in this U.S. urban cohort, with a pooled AUC of 0.85 (95% CI, 0.79–0.89), indicating strong discrimination between survivors and non-survivors. However, the model tended to overpredict mortality, especially at higher score ranges. The authors suggest this may reflect changes in COVID-19 management and improved treatments since the early pandemic period studied.<br /><br />Overall, the findings support the 4C Mortality Score as a useful tool for U.S. clinicians, while emphasizing that it should be applied cautiously and interpreted in light of local patient populations and evolving care practices.

Asset Subtitle

Joshua M. Riley

Meta Tag

Author List Alan Kubey, Albert Crawford, Chantel Venkataraman, Chris Li, Christa Smaltz, Conor Bradley, Crystal Lee, Danielle Fitzpatrick, David Ney, Dianna R. Cheney-Peters, Dina Zaret, Divya Chalikonda, Joseph Schaefer, Joshua M. Riley, Joshua Mairose, Kashyap

Category Research

Concept Mortality Prediction Model

Concept External Validation

Concept Mortality Prediction

Concept Discrimination

Concept Risk Stratification

Distinguished Non-Finalist

Presenter Organization Sidney Kimmel Medical College

Presenting Author Joshua M. Riley

Track Translating Research into Practice

Keywords

COVID-19

4C Mortality Score

in-hospital mortality

risk prediction

SARS-CoV-2

AUC

validation study

United States

urban cohort

multiple imputation

Mortality Prediction Model

External Validation

Mortality Prediction

Discrimination

Risk Stratification