External Validation of the Modified 4C Deterioration Model and 4C Mortality Score for COVID-19 Patients in a Swiss Tertiary Hospital
Prognostic models to predict the deterioration and mortality risk in COVID-19 patients are utterly needed to assist in informed decision making. Most of these models, however, are at high risk of bias, model overfitting, and unclear reporting. Here, we aimed to externally validate the modified (urea...
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| Format: | Article |
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MDPI AG
2022-05-01
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| Series: | Diagnostics |
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| Online Access: | https://www.mdpi.com/2075-4418/12/5/1129 |
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| author | Adriana Wirth Andrea Goetschi Ulrike Held Ataman Sendoel Melina Stuessi-Helbling Lars Christian Huber |
| author_facet | Adriana Wirth Andrea Goetschi Ulrike Held Ataman Sendoel Melina Stuessi-Helbling Lars Christian Huber |
| author_sort | Adriana Wirth |
| collection | DOAJ |
| description | Prognostic models to predict the deterioration and mortality risk in COVID-19 patients are utterly needed to assist in informed decision making. Most of these models, however, are at high risk of bias, model overfitting, and unclear reporting. Here, we aimed to externally validate the modified (urea was omitted) 4C Deterioration Model and 4C Mortality Score in a cohort of Swiss COVID-19 patients and, second, to evaluate whether the inclusion of the neutrophil-to-lymphocyte ratio (NLR) improves the predictive performance of the models. We conducted a retrospective single-centre study with adult patients hospitalized with COVID-19. Both prediction models were updated by including the NLR. Model performance was assessed via the models’ discriminatory performance (area under the curve, AUC), calibration (intercept and slope), and their performance overall (Brier score). For the validation of the 4C Deterioration Model and Mortality Score, 546 and 527 patients were included, respectively. In total, 133 (24.4%) patients met the definition of in-hospital deterioration. Discrimination of the 4C Deterioration Model was AUC = 0.78 (95% CI 0.73–0.82). A total of 55 (10.44%) patients died in hospital. Discrimination of the 4C Mortality Score was AUC = 0.85 (95% CI 0.79–0.89). There was no evidence for an incremental value of the NLR. Our data confirm the role of the modified 4C Deterioration Model and Mortality Score as reliable prediction tools for the risk of deterioration and mortality. There was no evidence that the inclusion of NLR improved model performance. |
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| format | Article |
| id | doaj.art-bdb6c27474244c90a95db862e74ef7a0 |
| institution | Directory Open Access Journal |
| issn | 2075-4418 |
| language | English |
| last_indexed | 2024-03-10T03:03:12Z |
| publishDate | 2022-05-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Diagnostics |
| spelling | doaj.art-bdb6c27474244c90a95db862e74ef7a02023-11-23T10:39:46ZengMDPI AGDiagnostics2075-44182022-05-01125112910.3390/diagnostics12051129External Validation of the Modified 4C Deterioration Model and 4C Mortality Score for COVID-19 Patients in a Swiss Tertiary HospitalAdriana Wirth0Andrea Goetschi1Ulrike Held2Ataman Sendoel3Melina Stuessi-Helbling4Lars Christian Huber5Clinic for Internal Medicine, Department of Internal Medicine, City Hospital Zurich, Triemli, 8063 Zurich, SwitzerlandDepartment of Biostatistics, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, 8001 Zurich, SwitzerlandDepartment of Biostatistics, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, 8001 Zurich, SwitzerlandInstitute for Regenerative Medicine, University of Zurich, 8952 Schlieren, SwitzerlandClinic for Internal Medicine, Department of Internal Medicine, City Hospital Zurich, Triemli, 8063 Zurich, SwitzerlandClinic for Internal Medicine, Department of Internal Medicine, City Hospital Zurich, Triemli, 8063 Zurich, SwitzerlandPrognostic models to predict the deterioration and mortality risk in COVID-19 patients are utterly needed to assist in informed decision making. Most of these models, however, are at high risk of bias, model overfitting, and unclear reporting. Here, we aimed to externally validate the modified (urea was omitted) 4C Deterioration Model and 4C Mortality Score in a cohort of Swiss COVID-19 patients and, second, to evaluate whether the inclusion of the neutrophil-to-lymphocyte ratio (NLR) improves the predictive performance of the models. We conducted a retrospective single-centre study with adult patients hospitalized with COVID-19. Both prediction models were updated by including the NLR. Model performance was assessed via the models’ discriminatory performance (area under the curve, AUC), calibration (intercept and slope), and their performance overall (Brier score). For the validation of the 4C Deterioration Model and Mortality Score, 546 and 527 patients were included, respectively. In total, 133 (24.4%) patients met the definition of in-hospital deterioration. Discrimination of the 4C Deterioration Model was AUC = 0.78 (95% CI 0.73–0.82). A total of 55 (10.44%) patients died in hospital. Discrimination of the 4C Mortality Score was AUC = 0.85 (95% CI 0.79–0.89). There was no evidence for an incremental value of the NLR. Our data confirm the role of the modified 4C Deterioration Model and Mortality Score as reliable prediction tools for the risk of deterioration and mortality. There was no evidence that the inclusion of NLR improved model performance.https://www.mdpi.com/2075-4418/12/5/1129COVID-19SARS-CoV-2hospitalpredictiondeteriorationmortality |
| spellingShingle | Adriana Wirth Andrea Goetschi Ulrike Held Ataman Sendoel Melina Stuessi-Helbling Lars Christian Huber External Validation of the Modified 4C Deterioration Model and 4C Mortality Score for COVID-19 Patients in a Swiss Tertiary Hospital Diagnostics COVID-19 SARS-CoV-2 hospital prediction deterioration mortality |
| title | External Validation of the Modified 4C Deterioration Model and 4C Mortality Score for COVID-19 Patients in a Swiss Tertiary Hospital |
| title_full | External Validation of the Modified 4C Deterioration Model and 4C Mortality Score for COVID-19 Patients in a Swiss Tertiary Hospital |
| title_fullStr | External Validation of the Modified 4C Deterioration Model and 4C Mortality Score for COVID-19 Patients in a Swiss Tertiary Hospital |
| title_full_unstemmed | External Validation of the Modified 4C Deterioration Model and 4C Mortality Score for COVID-19 Patients in a Swiss Tertiary Hospital |
| title_short | External Validation of the Modified 4C Deterioration Model and 4C Mortality Score for COVID-19 Patients in a Swiss Tertiary Hospital |
| title_sort | external validation of the modified 4c deterioration model and 4c mortality score for covid 19 patients in a swiss tertiary hospital |
| topic | COVID-19 SARS-CoV-2 hospital prediction deterioration mortality |
| url | https://www.mdpi.com/2075-4418/12/5/1129 |
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