A paper published today presents an easy to use risk stratification score developed and validated based on parameters available to doctors when COVID-19 patients are admitted to the hospital.
The 4C Mortality Score outperformed existing scores, showed utility to directly inform clinical decision making, and can be used to stratify patients admitted to hospital with COVID-19 into different management groups. The score should be further validated to determine its applicability in other populations.
The score comes from 8 factors, two of which are lab values (CRP, urea) but 5 of which are parameters that individuals either know (age, sex, comorbidities) or which are measurable at home on themselves with home monitoring devices (respiratory rate and peripheral oxygen saturation)
Add your score up and you can predict your chances of death from these charts.
A score of 20 gives you >80% chance of death whereas a 9 puts you at 20%.
With these charts and scores we can see how much greater the mortality is for a 66 year old, let’s say compared to one less than 50 years of age. Increasing a 9 by the +4 score increases the score to 13 and the mortality rate from 20% to around 40%.
It’s also interesting that 92% is the cut-point at which a low oxygen saturation adds points. More on this later but as I pointed out in my piece on buying a home oximeter, one study found 92% to be the oxygen saturation at which patients should head to the hospital.
Comorbidities collected were chronic cardiac disease, chronic respiratory disease (excluding asthma), chronic renal disease (estimated glomerular filtration rate ≤30), mild to severe liver disease, dementia, chronic neurological conditions, connective tissue disease, diabetes mellitus (diet, tablet, or insulin controlled), HIV or AIDS, and malignancy. These conditions were selected a priori by a global consortium to provide rapid, coordinated clinical investigation of patients presenting with any severe or potentially severe acute infection of public interest and enabled standardisation.
Clinician defined obesity was also included as a comorbidity owing to its probable association with adverse outcomes in patients with covid-19.