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

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.

Conflict of interest statement

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.

Copyright ©ERS 2020.