Corcoran John P, Psallidas Ioannis, Gerry Stephen, Piccolo Francesco, Koegelenberg Coenraad F, Saba Tarek, Daneshvar Cyrus, Fairbairn Ian, Heinink Richard, West Alex, Stanton Andrew E, Holme Jayne, Kastelik Jack A, Steer Henry, Downer Nicola J, Haris Mohammed, Baker Emma H, Everett Caroline F, Pepperell Justin, Bewick Thomas, Yarmus Lonny, Maldonado Fabien, Khan Burhan, Hart-Thomas Alan, Hands Georgina, Warwick Geoffrey, De Fonseka Duneesha, Hassan Maged, Munavvar Mohammed, Guhan Anur, Shahidi Mitra, Pogson Zara, Dowson Lee, Popowicz Natalia D, Saba Judith, Ward Neil R, Hallifax Rob J, Dobson Melissa, Shaw Rachel, Hedley Emma L, Sabia Assunta, Robinson Barbara, Collins Gary S, Davies Helen E, Yu Ly-Mee, Miller Robert F, Maskell Nick A, Rahman Najib M
Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
Oxford Respiratory Trials Unit, University of Oxford, Oxford, UK.
Eur Respir J. 2020 Nov 26;56(5). doi: 10.1183/13993003.00130-2020. Print 2020 Nov.
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.
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.
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.
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.
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.
超过30%的成年胸膜感染患者死亡和/或需要手术治疗。在基线评估时，尚无可靠方法预测哪些患者临床结局不佳。经过验证的风险预测评分可早期识别高危患者，从而可能在此后指导更积极的治疗。
前瞻性评估先前描述的胸膜感染成年患者风险评分（RAPID（肾脏（尿素）、年龄、积液脓性、感染源、饮食（白蛋白））评分）。
前瞻性观察队列研究，纳入接受胸膜感染治疗的患者。在基线评估时计算RAPID评分和风险类别。主要结局为3个月时的死亡率；次要结局为12个月时的死亡率、住院时间、胸外科手术需求、内科治疗失败情况以及3个月时的肺功能。
纳入的546例患者中有542例（99.3%）可获得死亡率数据。3个月时总体死亡率为10%（542例中的54例），12个月时为19%（542例中的102例）。RAPID风险类别可预测3个月时的死亡率。低风险死亡率（RAPID评分为0 - 2）：222例中的5例（2.3%，95%可信区间0.9至5.7%）；中等风险死亡率（RAPID评分为3 - 4）：228例中的21例（9.2%，95%可信区间6.0至13.7%）；高风险死亡率（RAPID评分为5 - 7）：92例中的27例（29.3%，95%可信区间21.0至39.2%）。3个月和12个月时评分的C统计量分别为0.78（95%可信区间0.71 - 0.83）和0.77（95%可信区间0.72 - 0.82）。
RAPID评分根据成年胸膜感染患者死亡风险的增加进行分层，应为今后旨在改善该患者群体结局的研究提供参考。
