{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T01:31:29Z","timestamp":1760146289132,"version":"build-2065373602"},"reference-count":22,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2024,10,12]],"date-time":"2024-10-12T00:00:00Z","timestamp":1728691200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Singapore National Medical Research Council","award":["COVID19RF-008"],"award-info":[{"award-number":["COVID19RF-008"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Viruses"],"abstract":"<jats:p>The ISARIC 4C Mortality score was developed to predict mortality risk among patients with COVID-19. Its performance among vaccinated individuals is understudied. This is a retrospective study of all patients with SARS-CoV-2 infection admitted to the National Centre for Infectious Diseases, Singapore, from January-2020 to December-2021. Demographic, clinical, and laboratory data were extracted, and multiple logistic regression (MLR) models were developed to predict the relationship between ISARIC score, vaccination status, anti-S antibody titre, and severe COVID-19. A total of 6377 patients were identified, of which 5329 met the study eligibility criteria. The median age of the patients was 47 years (IQR 35\u201371), 1264 (23.7%) were female, and 1239 (25.7%) were vaccinated. Severe disease occurred in 499 (9.4%) patients, including 133 (2.5%) deaths. After stratification, 3.0% of patients with low (0\u20134), 17.8% of patients with moderate (5\u20139), and 36.2% of patients with high (\u226510) ISARIC scores developed severe COVID-19. Vaccination was associated with a reduced risk of progression to severe COVID-19 in the MLR model: aOR 0.88 (95% CI: 0.86\u20130.90), and the risk of severe COVID-19 decreased inversely to anti-S antibody titres. The anti-S antibody titre should be further investigated as an adjunct to the ISARIC score to triage COVID-19 patients for hospital admission and antiviral therapy.<\/jats:p>","DOI":"10.3390\/v16101604","type":"journal-article","created":{"date-parts":[[2024,10,14]],"date-time":"2024-10-14T04:02:58Z","timestamp":1728878578000},"page":"1604","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Utility of ISARIC 4C Mortality Score, Vaccination History, and Anti-S Antibody Titre in Predicting Risk of Severe COVID-19"],"prefix":"10.3390","volume":"16","author":[{"given":"Lin Pin","family":"Koh","sequence":"first","affiliation":[{"name":"National Centre for Infectious Diseases, Singapore 308442, Singapore"},{"name":"Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 308232, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Travis Ren Teen","family":"Chia","sequence":"additional","affiliation":[{"name":"National Centre for Infectious Diseases, Singapore 308442, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1013-7364","authenticated-orcid":false,"given":"Samuel Sherng Young","family":"Wang","sequence":"additional","affiliation":[{"name":"National Centre for Infectious Diseases, Singapore 308442, Singapore"},{"name":"Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore 308433, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0003-541X","authenticated-orcid":false,"given":"Jean-Marc","family":"Chavatte","sequence":"additional","affiliation":[{"name":"National Centre for Infectious Diseases, Singapore 308442, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Robert","family":"Hawkins","sequence":"additional","affiliation":[{"name":"Department of Laboratory Medicine, Tan Tock Seng Hospital, Singapore 308433, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8682-9914","authenticated-orcid":false,"given":"Yonghan","family":"Ting","sequence":"additional","affiliation":[{"name":"Department of Radiology, Tan Tock Seng Hospital, Singapore 308433, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4164-1643","authenticated-orcid":false,"given":"Jordan Zheng Ting","family":"Sim","sequence":"additional","affiliation":[{"name":"Department of Radiology, Tan Tock Seng Hospital, Singapore 308433, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wen Xiang","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Radiology, Tan Tock Seng Hospital, Singapore 308433, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kelvin Bryan","family":"Tan","sequence":"additional","affiliation":[{"name":"Ministry of Health, 16 College Road, College of Medicine Building, Singapore 169854, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cher Heng","family":"Tan","sequence":"additional","affiliation":[{"name":"National Centre for Infectious Diseases, Singapore 308442, Singapore"},{"name":"Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 308232, Singapore"},{"name":"Department of Radiology, Tan Tock Seng Hospital, Singapore 308433, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0324-0205","authenticated-orcid":false,"given":"David Chien","family":"Lye","sequence":"additional","affiliation":[{"name":"National Centre for Infectious Diseases, Singapore 308442, Singapore"},{"name":"Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 308232, Singapore"},{"name":"Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore 308433, Singapore"},{"name":"Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Barnaby E.","family":"Young","sequence":"additional","affiliation":[{"name":"National Centre for Infectious Diseases, Singapore 308442, Singapore"},{"name":"Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 308232, Singapore"},{"name":"Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore 308433, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2024,10,12]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"2000058","DOI":"10.2807\/1560-7917.ES.2020.25.4.2000058","article-title":"Pattern of early human-to-human transmission of Wuhan 2019 novel coronavirus (2019-nCoV), December 2019 to January 2020","volume":"25","author":"Riou","year":"2020","journal-title":"Eurosurveillance"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"2351","DOI":"10.1016\/S0140-6736(22)00484-6","article-title":"Estimating global, regional, and national daily and cumulative infections with SARS-CoV-2 through Nov 14, 2021: A statistical analysis","volume":"399","author":"Barber","year":"2022","journal-title":"Lancet"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1513","DOI":"10.1016\/S0140-6736(21)02796-3","article-title":"Estimating excess mortality due to the COVID-19 pandemic: A systematic analysis of COVID-19-related mortality, 2020\u201321","volume":"399","author":"Wang","year":"2022","journal-title":"Lancet"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"458","DOI":"10.15585\/mmwr.mm6915e3","article-title":"Hospitalization Rates and Characteristics of Patients Hospitalized with Laboratory-Confirmed Coronavirus Disease 2019\u2014COVID-NET, 14 States, March 1\u201330, 2020","volume":"69","author":"Garg","year":"2020","journal-title":"Morb. Mortal. Wkly. Rep."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"884.e1","DOI":"10.1016\/j.cmi.2022.01.031","article-title":"External validation of the PRIORITY model in predicting COVID-19 critical illness in vaccinated and unvaccinated patients","volume":"28","author":"Ong","year":"2022","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"349","DOI":"10.1016\/S2213-2600(20)30559-2","article-title":"Development and validation of the ISARIC 4C Deterioration model for adults hospitalised with COVID-19: A prospective cohort study","volume":"9","author":"Gupta","year":"2021","journal-title":"Lancet Respir. Med."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"m3339","DOI":"10.1136\/bmj.m3339","article-title":"Risk stratification of patients admitted to hospital with COVID-19 using the ISARIC WHO Clinical Characterisation Protocol: Development and validation of the 4C Mortality Score","volume":"370","author":"Knight","year":"2020","journal-title":"BMJ"},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Sim, J.Z.T., Ting, Y.-H., Tang, Y., Feng, Y., Lei, X., Wang, X., Chen, W.-X., Huang, S., Wong, S.-T., and Lu, Z. (2022). Diagnostic Performance of a Deep Learning Model Deployed at a National COVID-19 Screening Facility for Detection of Pneumonia on Frontal Chest Radiographs. Healthcare, 10.","DOI":"10.3390\/healthcare10010175"},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Tariq, A., Lee, Y., Roosa, K., Blumberg, S., Yan, P., Ma, S., and Chowell, G. (2020). Real-time monitoring the transmission potential of COVID-19 in Singapore, March 2020. BMC Med., 18.","DOI":"10.1186\/s12916-020-01615-9"},{"key":"ref_10","unstructured":"(2023, March 17). MOH|News Highlights, Available online: https:\/\/www.moh.gov.sg\/news-highlights\/details\/preparing-for-our-transition-towards-covid-resilience."},{"key":"ref_11","unstructured":"(2023, March 17). MOH|News Highlights, Available online: https:\/\/www.moh.gov.sg\/news-highlights\/details\/data-on-persons-testing-positive-with-covid-19-serving-quarantine-orders-at-home-and-medical-treatment-provided-to-them\/."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1442","DOI":"10.1093\/cid\/ciac288","article-title":"Comparative Effectiveness of mRNA and Inactivated Whole-Virus Vaccines Against Coronavirus Disease 2019 Infection and Severe Disease in Singapore","volume":"75","author":"Premikha","year":"2022","journal-title":"Clin. Infect. Dis."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"100861","DOI":"10.1016\/j.eclinm.2021.100861","article-title":"SARS-CoV-2 antibody-positivity protects against reinfection for at least seven months with 95% efficacy","volume":"35","author":"Chemaitelly","year":"2021","journal-title":"eClinicalMedicine"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"e874","DOI":"10.1093\/cid\/ciac087","article-title":"Validation of ISARIC 4C Mortality and Deterioration Scores in a Mixed Vaccination Status Cohort of Hospitalized Coronavirus Disease 2019 (COVID-19) Patients in Singapore","volume":"75","author":"Ong","year":"2022","journal-title":"Clin. Infect. Dis."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1347","DOI":"10.1007\/s15010-024-02189-x","article-title":"Protective role of SARS-CoV-2 anti-S IgG against breakthrough infections among European healthcare workers during pre and post-Omicron surge-ORCHESTRA project","volume":"52","author":"Spiteri","year":"2024","journal-title":"Infection"},{"key":"ref_16","first-page":"712","article-title":"The Omicron-transformer: Rise of the subvariants in the age of vaccines","volume":"51","author":"Chia","year":"2022","journal-title":"Ann. Acad. Med."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"e00396-22","DOI":"10.1128\/spectrum.00396-22","article-title":"Rapid Quantitative Point-Of-Care Diagnostic Test for Post COVID-19 Vaccination Antibody Monitoring","volume":"10","author":"Moeller","year":"2022","journal-title":"Microbiol. Spectr."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"299","DOI":"10.1007\/s40801-024-00427-0","article-title":"Economic Evaluation of Nirmatrelvir\/Ritonavir Among Adults Against Hospitalization During the Omicron Dominated Period in Malaysia: A Real-World Evidence Perspective","volume":"11","author":"Low","year":"2024","journal-title":"Drugs-Real World Outcomes"},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Zhang, W., Li, L., Zhou, Z., Liu, Q., Wang, G., and Liu, D. (2023). Cost-effectiveness of Paxlovid in reducing severe COVID-19 and mortality in China. Front. Public Health, 11.","DOI":"10.3389\/fpubh.2023.1174879"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"e84","DOI":"10.1056\/NEJMoa2114583","article-title":"Waning Immune Humoral Response to BNT162b2 COVID-19 Vaccine over 6 Months","volume":"385","author":"Levin","year":"2021","journal-title":"N. Engl. J. Med."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1056\/NEJMoa2203965","article-title":"Effects of Previous Infection and Vaccination on Symptomatic Omicron Infections","volume":"387","author":"Altarawneh","year":"2022","journal-title":"N. Engl. J. Med."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"494","DOI":"10.1056\/NEJMc2119270","article-title":"Effectiveness of BNT162b2 Vaccine against Omicron Variant in South Africa","volume":"386","author":"Collie","year":"2022","journal-title":"N. Engl. J. Med."}],"container-title":["Viruses"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1999-4915\/16\/10\/1604\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T16:12:18Z","timestamp":1760112738000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1999-4915\/16\/10\/1604"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,10,12]]},"references-count":22,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2024,10]]}},"alternative-id":["v16101604"],"URL":"https:\/\/doi.org\/10.3390\/v16101604","relation":{},"ISSN":["1999-4915"],"issn-type":[{"type":"electronic","value":"1999-4915"}],"subject":[],"published":{"date-parts":[[2024,10,12]]}}}