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

被引：65

作者：

Corcoran, John P. ^{[1
,2
]}

Psallidas, Ioannis ^{[1
,2
]}

Gerry, Stephen ^{[3
]}

Piccolo, Francesco ^{[4
]}

Koegelenberg, Coenraad F. ^{[5
]}

Saba, Tarek ^{[6
]}

Daneshvar, Cyrus ^{[7
]}

Fairbairn, Ian ^{[8
]}

Heinink, Richard ^{[9
]}

West, Alex ^{[10
]}

Stanton, Andrew E. ^{[11
]}

Holme, Jayne ^{[12
]}

Kastelik, Jack A. ^{[13
]}

Steer, Henry ^{[14
]}

Downer, Nicola J. ^{[15
]}

Haris, Mohammed ^{[16
]}

Baker, Emma H. ^{[17
]}

Everett, Caroline F. ^{[18
]}

Pepperell, Justin ^{[19
]}

Bewick, Thomas ^{[20
]}

Yarmus, Lonny ^{[21
]}

Maldonado, Fabien ^{[22
]}

Khan, Burhan ^{[23
]}

Hart-Thomas, Alan ^{[24
]}

Hands, Georgina ^{[25
]}

Warwick, Geoffrey ^{[26
]}

De Fonseka, Duneesha ^{[27
]}

Hassan, Maged ^{[1
,2
,28
]}

Munavvar, Mohammed ^{[29
]}

Guhan, Anur ^{[30
]}

Shahidi, Mitra ^{[31
]}

Pogson, Zara ^{[32
]}

Dowson, Lee ^{[33
]}

Popowicz, Natalia D. ^{[4
]}

Saba, Judith ^{[6
]}

Ward, Neil R. ^{[7
]}

Hallifax, Rob J. ^{[1
,2
]}

Dobson, Melissa ^{[2
]}

Shaw, Rachel ^{[2
]}

Hedley, Emma L. ^{[2
]}

Sabia, Assunta ^{[2
]}

Robinson, Barbara ^{[2
]}

Collins, Gary S. ^{[3
]}

Davies, Helen E. ^{[34
]}

Yu, Ly-Mee ^{[35
]}

Miller, Robert F. ^{[36
]}

Maskell, Nick A. ^{[27
]}

Rahman, Najib M. ^{[1
,2
,37
]}

机构：

[1] Oxford Univ Hosp NHS Fdn Trust, Oxford Ctr Resp Med, Churchill Hosp Site, Oxford OX3 7LJ, England

[2] Univ Oxford, Oxford Resp Trials Unit, Oxford, England

[3] Univ Oxford, Nuffield Dept Orthopaed Rheumatol & Musculoskelet, Ctr Stat Med, Oxford, England

[4] Sir Charles Gairdner Hosp, Dept Resp Med, Perth, WA, Australia

[5] Stellenbosch Univ, Div Pulmonol, Dept Med, Cape Town, South Africa

[6] Blackpool Teaching Hosp NHS Fdn Trust, Blackpool, England

[7] Univ Hosp Plymouth NHS Trust, Plymouth, Devon, England

[8] Victoria Hosp, NHS Fife, Kirkcaldy, Scotland

[9] Shrewsbury & Telford Hosp NHS Trust, Shrewsbury, Salop, England

[10] Guys & St Thomas NHS Fdn Trust, London, England

[11] Great Western Hosp NHS Fdn Trust, Swindon, Wilts, England

[12] Univ Hosp South Manchester NHS Fdn Trust, Manchester, Lancs, England

[13] Hull & East Yorkshire Hosp NHS Trust, Kingston Upon Hull, N Humberside, England

[14] Gloucestershire Hosp NHS Fdn Trust, Cheltenham, Glos, England

[15] Sherwood Forest Hosp NHS Fdn Trust, Mansfield, England

[16] Univ Hosp North Midlands NHS Trust, Stoke On Trent, Staffs, England

[17] St Georges Univ London, Inst Infect & Immun, London, England

[18] York Teaching Hosp NHS Fdn Trust, York, N Yorkshire, England

[19] Taunton & Somerset NHS Fdn Trust, Taunton, Somerset, England

[20] Derby Teaching Hosp NHS Fdn Trust, Derby, England

[21] Johns Hopkins Univ, Div Pulm & Crit Care Med, Baltimore, MD USA

[22] Vanderbilt Univ, Sch Med, Div Allergy Pulm & Crit Care Med, Vanderbilt Ingram Canc Ctr, Nashville, TN USA

[23] Dartford & Gravesham NHS Trust, Dartford, England

[24] Calderdale & Huddersfield NHS Fdn Trust, Huddersfield, W Yorkshire, England

[25] Northern Devon Healthcare NHS Trust, Barnstaple, England

[26] Kings Coll Hosp NHS Fdn Trust, London, England

[27] Univ Bristol, Acad Resp Unit, Bristol, Avon, England

[28] Alexandria Univ, Chest Dis Dept, Fac Med, Alexandria, Egypt

[29] Lancashire Teaching Hosp NHS Fdn Trust, Preston, Lancs, England

[30] Univ Hosp Ayr, NHS Ayrshire & Arran, Ayr, Scotland

[31] Buckinghamshire Healthcare NHS Trust, Amersham, England

[32] United Lincolnshire Hosp NHS Trust, Lincoln, England

[33] Royal Wolverhampton Hosp NHS Trust, Wolverhampton, England

[34] Univ Hosp Wales, Cardiff, Wales

[35] Univ Oxford, Nuffield Dept Primary Care Hlth Sci, Oxford, England

[36] UCL, Inst Global Hlth, London, England

[37] Oxford NIHR Biomed Res Ctr, Oxford, England

来源：

EUROPEAN RESPIRATORY JOURNAL | 2020年 / 56卷 / 05期

基金：

英国医学研究理事会;

关键词：

ASSISTED THORACOSCOPIC SURGERY; COMPLICATED PARAPNEUMONIC EFFUSIONS; FIBRINOLYTIC THERAPY; PLASMINOGEN-ACTIVATOR; SURGICAL-TREATMENT; EMPYEMA; MANAGEMENT; THORACOTOMY; EMERGENCE; IDENTIFY;

D O I：

10.1183/13993003.00130-2020

中图分类号：

R56 [呼吸系及胸部疾病];

学科分类号：

摘要：

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.

引用

页数：13

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