Online tool identifies COVID-19 patients at highest risk of deterioration

Researchers have developed a new tool that can accurately predict the likelihood of deterioration in adults hospitalised with COVID-19.

The online tool, which has been made freely available to NHS doctors, could support clinical decision making, helping to improve patient outcomes and ultimately save lives. 

The tool assesses 11 measurements routinely collected from patients - including age, gender, and physical measurements (such as oxygen levels), along with some standard laboratory tests - and calculates a percentage risk of deterioration. 

The tool has been developed by researchers from the UK Coronavirus Clinical Characterisation Consortium (known as ISARIC4C), which is funded by the NIHR and UK Research and Innovation. 

The ‘4C Deterioration Score’, published in The Lancet Respiratory Medicine, builds on the consortium’s previous work developing the ‘4C Mortality Score’, which accurately predicts risk of death from COVID-19 after admission to hospital. The 4C Mortality Score is already recommended for use by NHS England to guide antiviral treatments (Remdesivir).

Co-senior author Professor Mahdad Noursadeghi, Professor of Infectious Diseases at UCL, said: “Accurate risk stratification at the point of admission to hospital will give doctors greater confidence about clinical decisions and planning ahead for the needs of individual patients. 

“The addition of the new 4C Deterioration Score alongside the 4C Mortality Score will provide clinicians with an evidence-based measure to identify those who will need  increased hospital support during their admission, even if they have a low risk of death.” 

The tool was developed using data from 74,944 people with COVID-19 admitted to 260 hospitals across England, Scotland and Wales, between February and August 2020. This includes 556 at Oxford’s John Radcliffe Hospital, 430 at Milton Keynes University Hospital, 1,164 at Reading’s Royal Berkshire Hospital, 497 at Aylesbury’s Stoke Mandeville Hospital and 58 at Wycombe Hospital. 

Researchers tested the 11 measures against the data from this large group of patients, to establish how, and to what to degree each of the measures affected the likelihood of deterioration.

They then assessed how well the tool performed in nine NHS regions and found that it performed similarly well in each, suggesting that it is likely to be useful across the NHS. Importantly, the new risk score performed better than previous risk scores.  

Read more about the ISARIC4C study on the University of Liverpool website.