Abstract
Background Over 30% of adult patients with pleural infection either die and/or require surgery. There is no robust means of predicting at baseline presentation which patients will suffer a poor clinical outcome. A validated risk prediction score would allow early identification of high-risk patients, potentially directing more aggressive treatment thereafter.
Objectives To prospectively assess a previously described risk score (RAPID - Renal (urea), Age, fluid Purulence, Infection source, Dietary (albumin)) in adults with pleural infection.
Methods Prospective observational cohort study recruiting patients undergoing treatment for pleural infection. RAPID score and risk category were calculated at baseline presentation. The primary outcome was mortality at 3 months; secondary outcomes were mortality at 12 months, length of hospital stay, need for thoracic surgery, failure of medical treatment, and lung function at 3 months.
Results Mortality data were available in 542 of 546 (99.3%) patients recruited. Overall mortality was 10% (54/542) at 3 months and 19% (102/542) at 12 months. The RAPID risk category predicted mortality at 3 months; low-risk (RAPID score 0–2) mortality 5/222 (2.3%, 95%CI 0.9 to 5.7), medium-risk (RAPID score 3–4) mortality 21/228 (9.2%, 95%CI 6.0 to 13.7), and high-risk (RAPID score 5–7) mortality 27/92 (29.3%, 95%CI 21.0 to 39.2). C-statistics for the score at 3 and 12 months were 0.78 (95%CI 0.71 to 0.83) and 0.77 (95%CI 0.72 to 0.82) respectively.
Conclusions The RAPID score stratifies adults with pleural infection according to increasing risk of mortality and should inform future research directed at improving outcomes in this patient population.
Footnotes
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Conflict of interest: Dr. Corcoran reports grants from UK Medical Research Council, during the conduct of the study.
Conflict of interest: Dr. Psallidas reports grants from UK Medical Research Council, during the conduct of the study; grants and personal fees from European Respiratory Society, outside the submitted work.
Conflict of interest: Mr. Gerry has nothing to disclose.
Conflict of interest: Dr. Piccolo has nothing to disclose.
Conflict of interest: Dr. Koegelenberg has nothing to disclose.
Conflict of interest: Ms. T. Saba has nothing to disclose.
Conflict of interest: Dr. Daneshvar has nothing to disclose.
Conflict of interest: Dr. Fairbairn has nothing to disclose.
Conflict of interest: Dr. Heinink has nothing to disclose.
Conflict of interest: Dr. West has nothing to disclose.
Conflict of interest: Dr. Stanton has nothing to disclose.
Conflict of interest: Dr. Holme has nothing to disclose.
Conflict of interest: Dr. Kastelik has nothing to disclose.
Conflict of interest: Dr. Steer has nothing to disclose.
Conflict of interest: Dr. Downer has nothing to disclose.
Conflict of interest: Dr. Haris has nothing to disclose.
Conflict of interest: Prof. Baker has nothing to disclose.
Conflict of interest: Dr. Everett has nothing to disclose.
Conflict of interest: Dr. Pepperell has nothing to disclose.
Conflict of interest: Dr. Bewick has nothing to disclose.
Conflict of interest: Dr. Yarmus has nothing to disclose.
Conflict of interest: Dr. Maldonado has nothing to disclose.
Conflict of interest: Dr. Khan has nothing to disclose.
Conflict of interest: Dr. Hart-Thomas has nothing to disclose.
Conflict of interest: Dr. Hands has nothing to disclose.
Conflict of interest: Dr. Warwick has nothing to disclose.
Conflict of interest: Dr. De Fonseka has nothing to disclose.
Conflict of interest: Dr. Hassan reports grants from UK Medical Research Council, during the conduct of the study.
Conflict of interest: Dr. Munavvar has nothing to disclose.
Conflict of interest: Dr. Guhan has nothing to disclose.
Conflict of interest: Dr. Shahidi has nothing to disclose.
Conflict of interest: Dr. Pogson has nothing to disclose.
Conflict of interest: Dr. Dowson has nothing to disclose.
Conflict of interest: Ms. Popowicz has nothing to disclose.
Conflict of interest: Ms. J. Saba has nothing to disclose.
Conflict of interest: Dr. Ward has nothing to disclose.
Conflict of interest: Dr. Hallifax reports grants from UK Medical Research Council, during the conduct of the study.
Conflict of interest: Ms. Dobson reports grants from UK Medical Research Council, during the conduct of the study.
Conflict of interest: Ms. Shaw reports grants from UK Medical Research Council, during the conduct of the study.
Conflict of interest: Ms. Hedley reports grants from UK Medical Research Council, during the conduct of the study.
Conflict of interest: Ms. Sabia reports grants from UK Medical Research Council, during the conduct of the study.
Conflict of interest: Ms. Robinson reports grants from UK Medical Research Council, during the conduct of the study.
Conflict of interest: Prof. Collins has nothing to disclose.
Conflict of interest: Dr. Davies has nothing to disclose.
Conflict of interest: Dr. Yu has nothing to disclose.
Conflict of interest: Dr. Miller has nothing to disclose.
Conflict of interest: Prof. Maskell has nothing to disclose.
Conflict of interest: Dr. Rahman reports grants from UK Medical Research Council, during the conduct of the study; personal fees from UK NIHR Oxford Biomedical Research Centre, outside the submitted work.
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- Received February 3, 2020.
- Accepted June 6, 2020.
- Copyright ©ERS 2020