A 4C mortality score based dichotomic rule supports Emergency Department discharge of COVID-19 patients

Morello, Fulvio; Bima, Paolo; Giamello, Jacopo Davide; Baricocchi, Denise; Risi, Francesca; Vesan, Matteo; Pivetta, Emanuele; Stefano, Giuliano De; Chiarlo, Michela; Veglia, Simona; SCHIVAZAPPA, Giulia; Mengozzi, Giulio; Lauria, Giuseppe; Podio, Stefano; Nazerian, Peiman; Aprà, Franco; Ferreri, Enrico; Lupia, Enrico

doi:10.23736/s0026-4806.21.07779-x

Cited by 6 publications

(7 citation statements)

References 28 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Città di Torino, 0031189/24 March 2020 and 0009810/29 January 2021). The general patient characteristics and validation of the 4CMS in this cohort have been previously described [ 11 ].…”

Section: Methodsmentioning

confidence: 99%

“…The 4CMS, described in Supplementary Table S2 , was calculated according to Knight et al [ 8 ]. If urea was not available, we used corresponding creatinine cutoff levels established on a training ED cohort of 832 patients subjected to a simultaneous urea/creatinine assay, as previously detailed [ 11 ].…”

Section: Methodsmentioning

confidence: 99%

“…For instance, the HOME-CoV (HCR), developed and validated in the ED, dichotomically identifies patients at a low risk of adverse events based on clinical presentation, course, comorbidities and living context. The 4C mortality score (4CMS), instead, developed on large inpatient cohorts, provides a graded risk-stratification (score 0 to 21) based on clinical presentation, comorbidities and selected blood test results [ 7 , 8 , 9 , 10 , 11 ]. However, the superiority of standardized rules/scores over subjective clinical judgment has not been shown, and the potential effects of these tools on hospital admission rates are largely unknown.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Lung Ultrasound Improves Outcome Prediction over Clinical Judgment in COVID-19 Patients Evaluated in the Emergency Department

Bima

Pivetta²,

Baricocchi³

et al. 2022

JCM

Self Cite

View full text Add to dashboard Cite

In the Emergency Department (ED), the decision to hospitalize or discharge COVID-19 patients is challenging. We assessed the utility of lung ultrasound (LUS), alone or in association with a clinical rule/score. This was a multicenter observational prospective study involving six EDs (NCT046291831). From October 2020 to January 2021, COVID-19 outpatients discharged from the ED based on clinical judgment were subjected to LUS and followed-up at 30 days. The primary clinical outcome was a composite of hospitalization or death. Within 393 COVID-19 patients, 35 (8.9%) reached the primary outcome. For outcome prognostication, LUS had a C-index of 0.76 (95%CI 0.68–0.84) and showed good performance and calibration. LUS-based classification provided significant differences in Kaplan–Meier curves, with a positive LUS leading to a hazard ratio of 4.33 (95%CI 1.95–9.61) for the primary outcome. The sensitivity and specificity of LUS for primary outcome occurrence were 74.3% (95%CI 59.8–88.8) and 74% (95%CI 69.5–78.6), respectively. The integration of LUS with a clinical score further increased sensitivity. In patients with a negative LUS, the primary outcome occurred in nine (3.3%) patients (p < 0.001 vs. unselected). The efficiency for rule-out was 69.7%. In unvaccinated ED patients with COVID-19, LUS improves prognostic stratification over clinical judgment alone and may support standardized disposition decisions.

show abstract

“…Città di Torino, 0031189/24 March 2020 and 0009810/29 January 2021). The general patient characteristics and validation of the 4CMS in this cohort have been previously described [ 11 ].…”

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Lung Ultrasound Improves Outcome Prediction over Clinical Judgment in COVID-19 Patients Evaluated in the Emergency Department

Bima

Pivetta²,

Baricocchi³

et al. 2022

JCM

Self Cite

View full text Add to dashboard Cite

show abstract

“…A high 4C score (≥15 out of 21) could identify patients at a high risk of mortality (positive predictive value 62%) [3]. This model has been further validated in several countries [1, 68–73]. Although some studies have shown a superior prognostic value of 4C over other risk scores such as CURB‐65 [74–76], others did not show such a trend [77, 78].…”

Section: Clinical Observationsmentioning

confidence: 99%

Effective prognostic and clinical risk stratification in COVID‐19 using multimodality biomarkers

et al. 2023

View full text Add to dashboard Cite

In acute coronavirus disease 19 (COVID‐19) patients, effective clinical risk stratification has important implications on treatment and therapeutic resource distribution. This article reviews the evidence behind a wide range of biomarkers with prognostic value in COVID‐19. Patient characteristics and co‐morbidities, such as cardiovascular and respiratory diseases, are associated with increased mortality risk. Peripheral oxygen saturation and arterial oxygenation are predictive of severe respiratory compromise, whereas risk scores such as the 4C‐score enable multi‐factorial prognostic risk estimation. Blood tests such as markers of inflammation, cardiac injury and d‐dimer and abnormalities on electrocardiogram are linked to inpatient prognosis. Of the imaging modalities, lung ultrasound and echocardiography enable the bedside assessment of prognostic abnormalities in COVID‐19. Chest radiograph (CXR) and computed tomography (CT) can inform about prognostic pulmonary pathologies, whereas cardiovascular CT detects high‐risk features such as coronary artery and aortic calcification. Dynamic changes in biomarkers, such as blood tests, CXR, CT and electrocardiogram findings, can further inform about disease severity and prognosis. Despite the vast volumes of existing evidence, several gaps exist in our understanding of COVID‐19 biomarkers. First, the pathophysiological basis on which these markers can foretell prognosis in COVID‐19 remains poorly understood. Second, certain under‐explored tests such as thoracic impedance assessment and cardiovascular magnetic resonance imaging deserve further investigation. Lastly, the prognostic values of most biomarkers in COVID‐19 are derived from retrospective analyses. Prospective studies are required to validate these markers for guiding clinical decision‐making and to facilitate their translation into clinical management pathways.

show abstract

“…MODS was defined as a SOFA score greater than 4 points persisting for more than 24 h or an increase of one point compared to the baseline SOFA score. 17 Additionally, the duration of ICU stay, presence of delirium, occurrence of arrhythmias, acute kidney injury based on the AKIN criteria, 20 orotracheal intubation, need for mechanical ventilation, vasopressor support, and use of extracorporeal membrane oxygenation (ECMO) were analyzed.…”

Section: Data Collectionmentioning

confidence: 99%

Oxygen Debt as Predictor of Mortality and Multiple Organ Dysfunction Syndrome in Severe COVID-19 Patients: A Retrospective Study

Perez-Garzon,

Poveda-Henao,

Bastidas-Goyes

et al. 2023

J Intensive Care Med

View full text Add to dashboard Cite

Background: Oxygen debt (DEOx) represents the disparity between resting and shock oxygen consumption (VO2) and is associated with metabolic insufficiency, acidosis, severity, and mortality. This study aimed to assess the reliability of DEOx as an indirect quantitative measure for predicting multiple organ dysfunction syndrome (MODS) and 28-day mortality in patients admitted to the intensive care unit (ICU) with respiratory syndrome severe acute coronavirus type 2 (SARS-CoV-2) infection, in comparison to the Acute Physiology and Chronic Health Evaluation II (APACHE II), sepsis-related organ failure assessment (SOFA), and 4C scores. Methods: A retrospective cohort study was conducted, including ICU patients with SARS-CoV-2 infection between 2020 and 2021. Clinical data were extracted from the EPIMED Monitor Database®. APACHE II, SOFA, and 4C scores were calculated upon ICU admission, and their accuracy in predicting 28-day mortality and MODS was compared to DEOx. Multivariate logistic regression analysis was performed to analyze the outcome variables. Results: 708 patients were included, with a mortality rate of 44.4%. DEOx value was 11.16 ml O2/kg. The mean age was 58.7 years. Multivariate analysis showed that DEOx was independently associated with mortality, intubation, and renal injury. Each point increase in creatinine was associated with a higher risk of MODS. To determine the precision of the scores, area under the receiver operating characteristic curves (AUROC) analysis was performed with weak discrimination and similar behavior for the primary outcomes. The most accurate scale for mortality and MODS was 4C with an AUC of 0.683 and APACHE II with an AUC of 0.814, while that of the AUROC of DEOx was 0.612 and 0.646, respectively. Conclusions: DEOx showed similar predictive value to established scoring systems in critically ill patients with SARS-CoV-2 infection. The correlation of DEOx with these scores may facilitate early intervention in critically ill patients.

show abstract

A 4C mortality score based dichotomic rule supports Emergency Department discharge of COVID-19 patients

Cited by 6 publications

References 28 publications

Lung Ultrasound Improves Outcome Prediction over Clinical Judgment in COVID-19 Patients Evaluated in the Emergency Department

Lung Ultrasound Improves Outcome Prediction over Clinical Judgment in COVID-19 Patients Evaluated in the Emergency Department

Effective prognostic and clinical risk stratification in COVID‐19 using multimodality biomarkers

Oxygen Debt as Predictor of Mortality and Multiple Organ Dysfunction Syndrome in Severe COVID-19 Patients: A Retrospective Study

Contact Info

Product

Resources

About