Hansen Linette Yde, Falster Casper, Bedawi Eihab, Bhatnagar Rahul, Bodtger Uffe, Laursen Christian B
Odense Respiratory Research Unit (ODIN), Department of Clinical Research, University of Southern Denmark.
Department of Emergency Medicine, Goedstrup Hospital, Herning.
Dan Med J. 2024 Jul 4;71(8):A01240071. doi: 10.61409/A01240071.
The incidence of pleural infection, a condition associated with increased mortality, is rising internationally. The RAPID (renal, age, purulence, infection source and dietary factor) score is a prognostic tool designed to stratify patients into risk categories based on five clinical baseline parameters. The aim of the study was to validate the RAPID score as a tool for assessment of prognosis, in the form of mortality, in patients with pleural infection in a Danish setting.
This was a retrospective observational cohort study including all patients coded with an International Classification of Diseases, version 10 (ICD-10) code for pleural infection (DJ86 Pyothorax) at a regional University Hospital in a five-year period. Medical records were reviewed retrospectively, RAPID scores were calculated and study participants were stratified into risk groups: low (RAPID scores: 0-2), medium (RAPID scores: 3-4) and high (RAPID scores: 5-7). The primary outcome was three-month mortality. Secondary outcomes were 12-month mortality, length of hospital stay, failure of initial medical treatment and surgical intervention.
Overall mortality at three months was 18.0%. Mortality according to RAPID risk category was as follows: Low risk 2.4% (95% confidence interval (CI): 0.1-12.6), medium risk 17.0% (95% CI: 7.7-30.8) and high risk 39.4% (95% CI 22.9-57.9). Hazard ratios for three-month mortality, with low risk as reference, were 7.5 (95% CI: 0.9-60.1; p = 0.057) for medium risk and 20.6 (95% CI: 2.7-157.6; p = 0.004) for high risk.
The findings of this study support the use of the RAPID score as a prognostic tool for assessment of mortality risk in patients with pleural infection in Danish healthcare.
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胸膜感染的发病率在国际上呈上升趋势，该病症与死亡率增加相关。RAPID（肾脏、年龄、脓性、感染源和饮食因素）评分是一种预后工具，旨在根据五个临床基线参数将患者分为不同风险类别。本研究的目的是在丹麦环境中验证RAPID评分作为评估胸膜感染患者死亡率预后工具的有效性。
这是一项回顾性观察队列研究，纳入了五年期间在一家地区大学医院被编码为国际疾病分类第10版（ICD - 10）胸膜感染代码（DJ86脓胸）的所有患者。对医疗记录进行回顾性审查，计算RAPID评分，并将研究参与者分为风险组：低风险（RAPID评分：0 - 2）、中风险（RAPID评分：3 - 4）和高风险（RAPID评分：5 - 7）。主要结局是三个月死亡率。次要结局是十二个月死亡率、住院时间、初始治疗失败和手术干预。
三个月时的总体死亡率为18.0%。根据RAPID风险类别划分的死亡率如下：低风险2.4%（95%置信区间（CI）：0.1 - 12.6），中风险17.0%（95%CI：7.7 - 30.8），高风险39.4%（95%CI 22.9 - 57.9）。以低风险为参照，中风险三个月死亡率的风险比为7.5（95%CI：0.9 - 60.1；p = 0.057），高风险为20.6（95%CI：2.7 - 157.6；p = 0.004）。
本研究结果支持将RAPID评分用作丹麦医疗保健中胸膜感染患者死亡风险评估的预后工具。
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