RN Tools
Age, years*
Sex at birth*
Number of comorbidities*
Comorbidities include 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.
Respiratory rate, breaths/min*
Peripheral oxygen saturation on room air*
Glasgow Coma Scale*
Select measurement available*
Urea*
C-reactive protein*
4C Mortality Score
0
points
In-hospital mortality
Predicts in-hospital mortality in patients admitted with COVID-19.
|
Variable |
Points | |
| Age, years |
<50 |
0 |
|
50-59 |
2 | |
|
60-69 |
4 | |
|
70-79 |
6 | |
|
≥80 |
7 | |
| Sex at birth |
Female |
0 |
|
Male |
1 | |
| Number of comorbidities* |
0 |
0 |
|
1 |
1 | |
|
≥2 |
2 | |
| Respiratory rate, breaths/min |
<20 |
0 |
|
20-29 |
1 | |
|
≥30 |
2 | |
| Peripheral oxygen saturation on room air |
≥92% |
0 |
|
<92% |
2 | |
|
15 |
0 | |
|
<15 |
2 | |
| Urea or BUN (use measurement available) |
Urea <7 mmol/L (<42 mg/dL) OR BUN <19.6 mg/dL |
0 |
|
Urea ≥7 to ≤14 mmol/L (≥42mg/dL to ≤84 mg/dL) OR BUN ≥19.6 to ≤39.2 mg/dL |
1 | |
|
Urea >14 mmol/L (>84 mg/dL) OR BUN >39.2 mg/dL |
3 | |
| C-reactive protein, mg/L |
<50 mg/L (<5 mg/dL) |
0 |
|
50-99 mg/L (5-9.9 mg/dL) |
1 | |
|
≥100 mg/L (≥10 mg/dL) |
2 | |
*Comorbidities include 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.
The 4C Mortality Score was derived from a prospective observational cohort study based upon positively tested COVID-19 patients admitted to 260 hospitals in England, Scotland and Wales. The score includes eight variables consisting of age, sex, number of comorbidities, respiratory rate, peripheral oxygen saturation, Glasgow coma scale score, urea level, and C-reactive protein. The score, ranging from 0-21, predicts in-hospital mortality from low risk to very high risk. The score, when compared against existing scores for CAP and COVID-19, performed better in predicting in-hospital mortality in the validation cohort.
The score performed well in the internal validation of the study along with external validation studies. The score is limited to determining in-patient hospital mortality and is not designed to be applicable to the outpatient setting. Overall generalizability of the score needs to be further investigated as it was derived and validated in a primarily homogeneous ethnic and age cohort.
Interpretation:
|
4C Mortality Score |
Risk group | In-hospital mortality |
|
0-3 |
Low | 1.2-1.7% |
|
4-8 |
Intermediate | 9.1-9.9% |
|
9-14 |
High | 31.4-34.9% |
|
≥15 |
Very high | 61.5-66.2% |
Risk stratification of admitted COVID-19 patients to aid in determining mortality risk, decision for level of care, and prognostication.
Apply to risk stratify patients who are admitted with COVID-19.
When applying to a hospitalized COVID-19 patient, score may be used in conjunction with clinical suspicion to determine mortality risk and appropriate level of care.