John P Corcoran1,2,3, Ioannis Psallidas1,2,3, Stephen Gerry4, Francesco Piccolo5, Coenraad F Koegelenberg6, Tarek Saba7, Cyrus Daneshvar8, Ian Fairbairn9, Richard Heinink10, Alex West11, Andrew E Stanton12, Jayne Holme13, Jack A Kastelik14, Henry Steer15, Nicola J Downer16, Mohammed Haris17, Emma H Baker18, Caroline F Everett19, Justin Pepperell20, Thomas Bewick21, Lonny Yarmus22, Fabien Maldonado23, Burhan Khan24, Alan Hart-Thomas25, Georgina Hands26, Geoffrey Warwick27, Duneesha De Fonseka28, Maged Hassan1,2,29, Mohammed Munavvar30, Anur Guhan31, Mitra Shahidi32, Zara Pogson33, Lee Dowson34, Natalia D Popowicz5, Judith Saba7, Neil R Ward8, Rob J Hallifax1,2, Melissa Dobson2, Rachel Shaw2, Emma L Hedley2, Assunta Sabia2, Barbara Robinson2, Gary S Collins4, Helen E Davies35, Ly-Mee Yu36, Robert F Miller37, Nick A Maskell28, Najib M Rahman1,2,38. 1. Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Foundation Trust, Oxford, UK. 2. Oxford Respiratory Trials Unit, University of Oxford, Oxford, UK. 3. Joint first authors, with equal contribution to study recruitment and manuscript writing. 4. Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK. 5. Dept of Respiratory Medicine, Sir Charles Gairdner Hospital, Perth, Australia. 6. Division of Pulmonology, Dept of Medicine, Stellenbosch University, Cape Town, South Africa. 7. Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, UK. 8. University Hospitals Plymouth NHS Trust, Plymouth, UK. 9. Victoria Hospital, NHS Fife, Kirkcaldy, UK. 10. Shrewsbury and Telford Hospital NHS Trust, Shrewsbury, UK. 11. Guy's and St Thomas' NHS Foundation Trust, London, UK. 12. Great Western Hospitals NHS Foundation Trust, Swindon, UK. 13. University Hospital of South Manchester NHS Foundation Trust, Manchester, UK. 14. Hull and East Yorkshire Hospitals NHS Trust, Hull, UK. 15. Gloucestershire Hospitals NHS Foundation Trust, Cheltenham, UK. 16. Sherwood Forest Hospitals NHS Foundation Trust, Mansfield, UK. 17. University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK. 18. Institute of Infection and Immunity, St George's, University of London, London, UK. 19. York Teaching Hospitals NHS Foundation Trust, York, UK. 20. Taunton and Somerset NHS Foundation Trust, Taunton, UK. 21. Derby Teaching Hospitals NHS Foundation Trust, Derby, UK. 22. Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, USA. 23. Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, Nashville, TN, USA. 24. Dartford and Gravesham NHS Trust, Dartford, UK. 25. Calderdale and Huddersfield NHS Foundation Trust, Huddersfield, UK. 26. Northern Devon Healthcare NHS Trust, Barnstaple, UK. 27. King's College Hospital NHS Foundation Trust, London, UK. 28. Academic Respiratory Unit, University of Bristol, Bristol, UK. 29. Chest Diseases Dept, Faculty of Medicine, Alexandria University, Alexandria, Egypt. 30. Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK. 31. University Hospital Ayr, NHS Ayrshire and Arran, Ayr, UK. 32. Buckinghamshire Healthcare NHS Trust, Amersham, UK. 33. United Lincolnshire Hospitals NHS Trust, Lincoln, UK. 34. Royal Wolverhampton Hospital NHS Trust, Wolverhampton, UK. 35. University Hospital of Wales, Cardiff, UK. 36. Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK. 37. Institute for Global Health, University College London, London, UK. 38. Oxford NIHR Biomedical Research Centre, Oxford, UK.
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.
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.
Authors: Christopher R Gilbert; Anee S Jackson; Candice L Wilshire; Leah C Horslen; Shu-Ching Chang; Adam J Bograd; Eric Vallieres; Jed A Gorden Journal: BMC Pulm Med Date: 2021-04-23 Impact factor: 3.317
Authors: Nikolaos I Kanellakis; John M Wrightson; Stephen Gerry; Nicholas Ilott; John P Corcoran; Eihab O Bedawi; Rachelle Asciak; Andrey Nezhentsev; Anand Sundaralingam; Rob J Hallifax; Greta M Economides; Lucy R Bland; Elizabeth Daly; Xuan Yao; Nick A Maskell; Robert F Miller; Derrick W Crook; Timothy S C Hinks; Tao Dong; Ioannis Psallidas; Najib M Rahman Journal: Lancet Microbe Date: 2022-03-11