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 (the RAPID (Renal (urea), Age, fluid Purulence, Infection source, Dietary (albumin)) score) in adults with pleural infection.
Methods Prospective observational cohort study that recruited 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 out of 546 patients recruited (99.3%). Overall mortality was 10% at 3 months (54 out of 542) and 19% at 12 months (102 out of 542). The RAPID risk category predicted mortality at 3 months. Low-risk mortality (RAPID score 0–2): five out of 222 (2.3%, 95% CI 0.9 to 5.7%); medium-risk mortality (RAPID score 3–4): 21 out of 228 (9.2%, 95% CI 6.0 to 13.7%); and high-risk mortality (RAPID score 5–7): 27 out of 92 (29.3%, 95% CI 21.0 to 39.2%). C-statistics for the scores at 3 months and 12 months were 0.78 (95% CI 0.71–0.83) and 0.77 (95% CI 0.72–0.82), 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.
Abstract
This multicentre observational study shows that RAPID score can stratify adults with pleural infection into categories according to increasing risk of 3-month mortality and should inform future research directed at improving outcomes in this population https://bit.ly/37tk2LN
Footnotes
This article has an editorial commentary: https://doi.org/10.1183/13993003.02425-2020.
This study is registered as a clinical trial: ISRCTN 50236700.
This article has supplementary material available from erj.ersjournals.com
Author contributions: J.P. Corcoran, N.A. Maskell and N.M. Rahman designed the study. J.P. Corcoran, I. Psallidas, F. Piccolo, C.F. Koegelenberg, T. Saba, C. Daneshvar, I. Fairbairn, R. Heinink, A. West, A.E. Stanton, J. Holme, J.A. Kastelik, H. Steer, N.J. Downer, M. Haris, E.H. Baker, C.F. Everett, J. Pepperell, T. Bewick, L. Yarmus, F. Maldonado, B. Khan, A. Hart-Thomas, G. Hands, G. Warwick, D. De Fonseka, M. Hassan, M. Munavvar, A. Guhan, M. Shahidi, Z. Pogson, L. Dowson, N.D. Popowicz, J. Saba, N.R. Ward, R.J. Hallifax, N.A. Maskell and N.M. Rahman recruited study patients. S. Gerry, G.S. Collins and L-M. Yu performed the statistical analysis and model validation. M. Dobson, R. Shaw, E.L. Hedley, A. Sabia, B. Robinson and R.F. Miller supported the study management team including data entry. I. Psallidas, J.P. Corcoran, S. Gerry, N.A. Maskell, R.F. Miller and N.M. Rahman wrote the first version of the manuscript. All authors subsequently revised and approved the final version of the manuscript for submission. Further details relating to membership of the PILOT Study Group can be found in the supplementary material.
Conflict of interest: J.P. Corcoran reports grants from the UK Medical Research Council (MRC; grant number G1001128), during the conduct of the study.
Conflict of interest: I. Psallidas reports grants from the UK MRC (grant number G1001128), during the conduct of the study, as well as grants and personal fees from the European Respiratory Society (ERS), outside the submitted work.
Conflict of interest: S. Gerry has nothing to disclose.
Conflict of interest: F. Piccolo has nothing to disclose.
Conflict of interest: C.F. Koegelenberg has nothing to disclose.
Conflict of interest: T. Saba has nothing to disclose.
Conflict of interest: C. Daneshvar has nothing to disclose.
Conflict of interest: I. Fairbairn has nothing to disclose.
Conflict of interest: R. Heinink has nothing to disclose.
Conflict of interest: A. West has nothing to disclose.
Conflict of interest: A.E. Stanton has nothing to disclose.
Conflict of interest: J. Holme has nothing to disclose.
Conflict of interest: J.A. Kastelik has nothing to disclose.
Conflict of interest: H. Steer has nothing to disclose.
Conflict of interest: N.J. Downer has nothing to disclose.
Conflict of interest: M. Haris has nothing to disclose.
Conflict of interest: E.H. Baker has nothing to disclose.
Conflict of interest: C.F. Everett has nothing to disclose.
Conflict of interest: J. Pepperell has nothing to disclose.
Conflict of interest: T. Bewick has nothing to disclose.
Conflict of interest: L. Yarmus has nothing to disclose.
Conflict of interest: F. Maldonado has nothing to disclose.
Conflict of interest: B. Khan has nothing to disclose.
Conflict of interest: A. Hart-Thomas has nothing to disclose.
Conflict of interest: G. Hands has nothing to disclose.
Conflict of interest: G. Warwick has nothing to disclose.
Conflict of interest: D. De Fonseka has nothing to disclose.
Conflict of interest: M. Hassan reports grants from the UK MRC (grant number G1001128), during the conduct of the study.
Conflict of interest: M. Munavvar has nothing to disclose.
Conflict of interest: A. Guhan has nothing to disclose.
Conflict of interest: M. Shahidi has nothing to disclose.
Conflict of interest: Z. Pogson has nothing to disclose.
Conflict of interest: L. Dowson has nothing to disclose.
Conflict of interest: N.D. Popowicz has nothing to disclose.
Conflict of interest: J. Saba has nothing to disclose.
Conflict of interest: N.R. Ward has nothing to disclose.
Conflict of interest: R.J. Hallifax reports grants from the UK MRC (grant number G1001128), during the conduct of the study.
Conflict of interest: M. Dobson reports grants from the UK MRC (grant number G1001128), during the conduct of the study.
Conflict of interest: R. Shaw reports grants from the UK MRC (grant number G1001128), during the conduct of the study.
Conflict of interest: E.L. Hedley reports grants from the UK MRC (grant number G1001128), during the conduct of the study.
Conflict of interest: A. Sabia reports grants from the UK MRC (grant number G1001128), during the conduct of the study.
Conflict of interest: B. Robinson reports grants from the UK MRC (grant number G1001128), during the conduct of the study.
Conflict of interest: G.S. Collins has nothing to disclose.
Conflict of interest: H.E. Davies has nothing to disclose.
Conflict of interest: L-M. Yu has nothing to disclose.
Conflict of interest: R.F. Miller has nothing to disclose.
Conflict of interest: N.A. Maskell has nothing to disclose.
Conflict of interest: N.M. Rahman reports grants from the UK MRC (grant number G1001128), during the conduct of the study, as well as personal fees from the UK National Institute for Health Research (NIHR) Oxford Biomedical Research Centre, outside the submitted work.
Support statement: The study was funded by the UK Medical Research Council (MRC; grant number G1001128). N.M. Rahman is funded by the UK National Institute for Health Research (NIHR) Oxford Biomedical Research Centre Programme. None of the funders had any influence on study design, delivery, analysis, or manuscript preparation. Funding information for this article has been deposited with the Crossref Funder Registry.
- Received February 3, 2020.
- Accepted June 6, 2020.
- Copyright ©ERS 2020
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