ABSTRACT
The aim of the study is to validate the Russian version of the 4C Mortality Score scale and evaluate its accuracy in predicting the outcomes of severe COVID-19. Material and methods. The staff of the Center for Validation of International Scales and Questionnaires of the Research Center of Neurology received official permission from the authors to conduct a validation study of the 4C Mortality Score scale in Russia. In the course of the work, the linguistic and cultural ratification of the scale was carried out and its Russian-language version was prepared. Psychometric properties (reliability and validity) The Russian-language version was evaluated on a group of 78 patients (37 of whom were men, aged 34 to 88 years) with a confirmed diagnosis of COVID-19, hospitalized in the City Clinical Hospital No. 15 named after O.M. Filatov (Moscow) in the period from June to August 2021. Results. The linguocultural adaptation of the 4C Mortality Score scale was successfully carried out. High levels of reliability were obtained (Spearman correlation coefficient rho=0.91, p<0.0001;Cronbach's alpha alpha=0.73, p=0.0002;Cohen's kappa kappa=0.85, p<0.0001). It is shown that the 4C Mortality Score scores have a significant correlation with the COVID-GRAM scores (r=0.72, p=0.002) and NEWS2 (r=0.54, p=0.004). Conclusion. As a result of the validation study, the official Russian version of the 4C Mortality Score scale was developed. It is recommended for use by medical professionals of various specialties at all stages of providing medical care to patients with COVID-19. The scale is available for download on the website of the Center for Validation of International Scales and Questionnaires of the Research Center of Neurology (https://www.neurology.ru/reabilitaciya/centr-validacii-mezhdunarodnyh-shkal-i-oprosnikov).Copyright © 2022 by the authors.
ABSTRACT
Introduction: The International Severe Acute Respiratory and emerging infections Consortium-Coronavirus Clinical Characterization Consortium (ISARIC 4C). Mortality Score is a risk stratification score that predicts in-hospital mortality for hospitalised Corona Virus Disease 2019 (COVID-19) patients, produced by the ISARIC 4C consortium.1 ISARIC 4C Mortality score is an easy to use eight variable score (Table 1) that helps in accurate stratification of hospitalized COVID-19 patients by mortality risk at hospital presentation and if applied within the validation cohorts could guide clinician decisions including escalation of care plans.1 It is unknown whether this score is validated for patients with most severe form of the disease. We aimed to evaluate its efficacy in a cohort of patients who all required invasive prone ventilation. Objectives: 1. Validate ISARIC 4c score for a subset of patients admitted to Critical Care, Royal Preston Hospital, requiring invasive ventilation and proning 2. Compare predicted mortality at hospitalization and at Intensive care unit (ICU) admission, with the actual observed mortality Methods: We analysed 96 patients from our electronic patient record (Quadramed) requiring invasive ventilation and proning, and calculated ISARIC 4c scores and predicted mortality at hospitalization and at ICU admission. We classified them into 4 groups, depending on their scores, as shown in Table 2. Results: 1. 55% of patients were admitted to ICU on same day of hospitalization, 29% within 3 days and 16% beyond 3 days. 2. Overall observed mortality for this cohort of patients was 57(59%) excluding outcome for 11 patients who were transferred out to Other ICUs. 3. The number of patients with predicted low, intermediate, and high risk of death seemed to underestimate the risk of death as their actual mortality was close to 50%. The mortality rate was close to predicted rate in the very high-risk group (Graph 1) Conclusion: The ISARIC 4C score-based prediction did not accurately reflect the actual observed mortality rates in this cohort of patients, particularly in the low, intermediate, and high risk of death groups. A very high risk of death, as predicted by the score correlated well with the actual mortality. In our opinion the ISARIC 4C scores underestimated the risk of death in this cohort of critically ill patients. The reasons for the underestimation could be inherent in the pathophysiology of the disease, causing unpredictable progression of disease and development of secondary complications in ICU. It would be interesting to determine if traditional ICU mortality prediction scores like APACHE2 and SOFA3 scores fare any better than ISARIC 4C. Further evaluation on a larger cohort of critically ill patients will be necessary.