Prospective validation of the RAPID clinical risk prediction score in adult patients with pleural infection: the PILOT study.

John P Corcoran, Ioannis Psallidas, Stephen Gerry, Francesco Piccolo, Coenraad F Koegelenberg, Tarek Saba, Cyrus Daneshvar, Ian Fairbairn, Richard Heinink, Alex West, Andrew E Stanton, Jayne Holme, Jack A Kastelik, Henry Steer, Nicola J Downer, Mohammed Haris, Emma H Baker, Caroline F Everett, Justin Pepperell, Thomas Bewick, Lonny Yarmus, Fabien Maldonado, Burhan Khan, Alan Hart-Thomas, Georgina Hands, Geoffrey Warwick, Duneesha De Fonseka, Maged Hassan, Mohammed Munavvar, Anur Guhan, Mitra Shahidi, Zara Pogson, Lee Dowson, Natalia D Popowicz, Judith Saba, Neil R Ward, Rob J Hallifax, Melissa Dobson, Rachel Shaw, Emma L Hedley, Assunta Sabia, Barbara Robinson, Gary S Collins, Helen E Davies, Ly-Mee Yu, Robert F Miller, Nick A Maskell, Najib M Rahman

Journal: The European respiratory journal 2021;56(5):2000130

PMID: 32675200

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.

Copyright ©ERS 2020.

Address: Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.; Oxford Respiratory Trials Unit, University of Oxford, Oxford, UK.; Joint first authors, with equal contribution to study recruitment and manuscript writing.; Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.; Dept of Respiratory Medicine, Sir Charles Gairdner Hospital, Perth, Australia.; Division of Pulmonology, Dept of Medicine, Stellenbosch University, Cape Town, South Africa.; Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, UK.; University Hospitals Plymouth NHS Trust, Plymouth, UK.; Victoria Hospital, NHS Fife, Kirkcaldy, UK.; Shrewsbury and Telford Hospital NHS Trust, Shrewsbury, UK.; Guy's and St Thomas' NHS Foundation Trust, London, UK.; Great Western Hospitals NHS Foundation Trust, Swindon, UK.; University Hospital of South Manchester NHS Foundation Trust, Manchester, UK.; Hull and East Yorkshire Hospitals NHS Trust, Hull, UK.; Gloucestershire Hospitals NHS Foundation Trust, Cheltenham, UK.; Sherwood Forest Hospitals NHS Foundation Trust, Mansfield, UK.; University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK.; Institute of Infection and Immunity, St George's, University of London, London, UK.; York Teaching Hospitals NHS Foundation Trust, York, UK.; Taunton and Somerset NHS Foundation Trust, Taunton, UK.; Derby Teaching Hospitals NHS Foundation Trust, Derby, UK.; Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, USA.; Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, Nashville, TN, USA.; Dartford and Gravesham NHS Trust, Dartford, UK.; Calderdale and Huddersfield NHS Foundation Trust, Huddersfield, UK.; Northern Devon Healthcare NHS Trust, Barnstaple, UK.; King's College Hospital NHS Foundation Trust, London, UK.; Academic Respiratory Unit, University of Bristol, Bristol, UK.; Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.; Oxford Respiratory Trials Unit, University of Oxford, Oxford, UK.; Chest Diseases Dept, Faculty of Medicine, Alexandria University, Alexandria, Egypt.; Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK.; University Hospital Ayr, NHS Ayrshire and Arran, Ayr, UK.; Buckinghamshire Healthcare NHS Trust, Amersham, UK.; United Lincolnshire Hospitals NHS Trust, Lincoln, UK.; Royal Wolverhampton Hospital NHS Trust, Wolverhampton, UK.; Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.; Oxford Respiratory Trials Unit, University of Oxford, Oxford, UK.; Oxford Respiratory Trials Unit, University of Oxford, Oxford, UK.; University Hospital of Wales, Cardiff, UK.; Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.; Institute for Global Health, University College London, London, UK.; Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.; Oxford Respiratory Trials Unit, University of Oxford, Oxford, UK.; Oxford NIHR Biomedical Research Centre, Oxford, UK.
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