Clinical Utility of 4C Mortality Scores among Japanese COVID‐19 Patients: A Multicenter Study

Kazuki Ocho, Hideharu Hagiya, Kou Hasegawa, Koji Fujita, Fumio Otsuka

Research output: Contribution to journalArticlepeer-review

8 Citations (Scopus)


Background: We analyzed data from COVID‐19 patients in Japan to assess the utility of the 4C mortality score as compared with conventional scorings. Methods: In this multicenter study, COVID‐19 patients hospitalized between March 2020 and June 2021, over 16 years old, were re-cruited. The superiority for correctly predicting mortality and severity by applying the receiver operating characteristic (ROC) curve was compared. A Cox regression model was used to compare the length of hospitalization for each risk group of 4C mortality score. Results: Among 206 patients, 21 patients died. The area under the curve (AUC) (95% confidential interval (CI)) of the ROC curve for mortality and severity, respectively, of 4C mortality scores (0.84 (95% CI 0.76–0.92) and 0.85 (95% CI 0.80–0.91)) were higher than those of qSOFA (0.66 (95% CI 0.53–0.78) and 0.67 (95% CI 0.59–0.75)), SOFA (0.70 (95% CI 0.55–0.84) and 0.81 (95% CI 0.74–0.89)), A‐DROP (0.78 (95% CI 0.69–0.88) and 0.81 (95% CI 0.74–0.88)), and CURB‐65 (0.82 (95% CI 0.74–0.90) and 0.82 (95% CI 0.76–0.88)). For length of hospitalization among survivors, the intermediate‐ and high‐ or very high‐risk groups had significantly lower hazard ratios, i.e., 0.48 (95% CI 0.30–0.76)) and 0.23 (95% CI 0.13–0.43) for dis-charge. Conclusions: The 4C mortality score is better for estimating mortality and severity in COVID‐19 Japanese patients than other scoring systems.

Original languageEnglish
Article number821
JournalJournal of Clinical Medicine
Issue number3
Publication statusPublished - Feb 1 2022


  • 4C mortality score
  • Clinical score
  • COVID‐19
  • Length of hospitalization
  • Mortality
  • Severity

ASJC Scopus subject areas

  • Medicine(all)


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