The prognostic value of the 4C Mortality Score in predicting mortality in severe and critical COVID-19 patients hospitalized within 24 hours at the Intensive Care Unit 1, Center for COVID-19 Critical Care and Treatment, Bach Mai Hospital

ABSTRACT

Objective: To evaluate the prognostic value of the ISARIC 4C Mortality Score for in-hospital death among severe and critical COVID-19 patients admitted to the intensive care unit (ICU), Center for COVID-19 Critical Care and Treatment, Bach Mai Hospital.

Participants and Methods: A single-centre retrospective study was conducted at Intensive Care Unit 1, Center for COVID-19 Critical Care and Treatment, Bach Mai Hospital, on adults with severe or critical COVID-19 admitted between 30 August and 28 September 2021. The 4C Mortality Score (range 0–21) was calculated from admission age, sex, number of comorbidities, respiratory rate, peripheral oxygen saturation (SpO₂), Glasgow Coma Scale, serum urea and C-reactive protein.

Results: Total of 82 patients had a complete 4C Mortality Score and were analysed; 34 (41.5%) died in hospital. The median score was higher in non-survivors than survivors (11 [IQR 9–15] vs 7 [2–10], p<0.001). The total score discriminated death well (AUROC 0.795, 95% CI 0.702–0.889), out-performing every individual component. Observed mortality rose monotonically across the four risk strata (Low 0%, Intermediate 31.8%, High 54.5%, Very high 90.0%) but exceeded the originally reported mortality at every non-low stratum. A cut-off of ≥9 was optimal (sensitivity 79.4%, specificity 66.7%, positive predictive value 62.8%, negative predictive value 82.1%, accuracy 72.0%); each 1-point increase raised the odds of death by 34% (OR 1.34, 95% CI 1.17–1.55, p<0.001) and the hazard of death by 21% (HR 1.21, 95% CI 1.11–1.31, p<0.001).

Conclusion: Computed from admission data, the 4C Mortality Score retained good discrimination and ordered risk well in severe and critical COVID-19 ICU patients, but its original risk bands under-estimated mortality in this already-critically-ill population; a higher cut-off (≥9) is more useful for ICU triage.

Keywords: COVID-19, 4C Mortality Score, intensive care, prognosis, mortality, Bach Mai Hospital

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