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A Clinical Score (RAPID) to Identify Those at Risk for Poor Outcome at Presentation in Patients With Pleural Infection

Rahman, NM; Kahan, BC; Miller, RF; Gleeson, FV; Nunn, AJ; Maskell, NA; (2014) A Clinical Score (RAPID) to Identify Those at Risk for Poor Outcome at Presentation in Patients With Pleural Infection. Chest , 145 (4) pp. 848-855. 10.1378/chest.13-1558. Green open access

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Abstract

BACKGROUND: Pleural infection is associated with a high morbidity and mortality. Development of a validated clinical risk score at presentation to identify those at high risk of dying would enable patient triage and may help formulate early management strategies. METHODS: A clinical risk score was derived based on data from patients entering the multicenter UK pleural infection trial (first Multicenter Intrapleural Sepsis Trial [MIST1], n = 411). From 22 baseline clinical characteristics, model selection was undertaken to find variables predictive of poor clinical outcome. Outcomes were mortality at 3 months (primary), need for surgical intervention at 3 months, and time from randomization to discharge. The derived scoring system RAPID (renal, age, purulence, infection source, and dietary factors) was validated using patients enrolled in the subsequent MIST2 trial (n = 191). RESULTS: Age, urea, albumin, hospital-acquired infection, and nonpurulence predicted poor outcome. Patients were stratified into low-risk (0-2), medium-risk (3-4), and high-risk (5-7) groups. Using the low-risk group as a reference, a RAPID score of 3 to 4 and > 4 was associated with an OR of 24.4 (95% CI, 3.1-186.7; P = .002) and 192.4 (95% CI, 25.0-1480.4; P < .001), respectively, for death at 3 months. In the validation cohort (MIST2), a medium-risk RAPID score was nonsignificantly associated with mortality (OR, 3.2; 95% CI, 0.8-13.2; P = .11), and a high-risk score was associated with increased mortality (OR, 14.1; 95% CI, 3.5-56.8; P < .001). Hospitalization duration was associated with increasing RAPID score (score 0-2: median duration = 7, interquartile range 6-13; score > 5: median duration = 15, interquartile range 9-28, P = .08). CONCLUSIONS: The RAPID score may permit risk stratification of patients with pleural infection at presentation.

Type: Article
Title: A Clinical Score (RAPID) to Identify Those at Risk for Poor Outcome at Presentation in Patients With Pleural Infection
Open access status: An open access version is available from UCL Discovery
DOI: 10.1378/chest.13-1558
Publisher version: http://dx.doi.org/10.1378/chest.13-1558
Language: English
Additional information: Copyright © 2014 The American College of Chest Physicians. Published by Elsevier Inc. All rights reserved. This manuscript version is made available under the CC-BY-NC-ND 4.0 license (http://creativecommons.org/licenses/by-nc-nd/4.0/)
Keywords: Critical Care Medicine, Respiratory System, Assisted Thoracoscopic Surgery, Parapneumonic Effusions, Surgical-treatment, Childhood Empyema, Thoracic Empyema, Randomized-trial, Management, Decortication, Debridement, Guideline
UCL classification: UCL
UCL > Provost and Vice Provost Offices
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Inst of Clinical Trials and Methodology
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Inst of Clinical Trials and Methodology > MRC Clinical Trials Unit at UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute for Global Health
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute for Global Health > Infection and Population Health
URI: https://discovery.ucl.ac.uk/id/eprint/1430484
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