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<jats:sec><jats:title>Background</jats:title><jats:p>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.</jats:p></jats:sec><jats:sec><jats:title>Objectives</jats:title><jats:p>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.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>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.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>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.</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>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.</jats:p></jats:sec>

Original publication

DOI

10.1183/13993003.00130-2020

Type

Journal article

Journal

European Respiratory Journal

Publisher

European Respiratory Society (ERS)

Publication Date

11/2020

Volume

56

Pages

2000130 - 2000130