Prognosticating pleural infection based on RAPID score in a tertiary-care hospital
DOI:
https://doi.org/10.61529/idjp.v34i3.451Keywords:
Pleural infection, RAPID score, Mortality, Prognosis, Tertiary careAbstract
Background: Pleural infection remains a significant cause of morbidity and mortality worldwide. The study aims to determine the mortality risk in patients with pleural infection using the renal function, Age, Purulence of pleural fluid, infection source, and dietary status (RAPID) score.
Material and Methods: A cross-sectional study was conducted at the Chest Unit-1, Ojha Institute of Chest Diseases, Dow University of Health Sciences. A total of 171 patients aged 18–80 years with confirmed pleural infection were enrolled through non-probability consecutive sampling. Demographic, clinical, laboratory, and pleural fluid data were collected, and the RAPID score was calculated for each patient. Data were analyzed using SPSS V.25, Quantitative variables were reported as mean ± SD or median (IQR) based on distribution, and categorical variables as frequencies and percentages. Associations were tested using chi-square or Fisher’s exact test.
Results: Of the 171 patients, 75 (43.9 %) were male, and the mean age was 55.1 ± 13.05 years. RAPID score distribution was low risk in 78 (45.6%), moderate in 58 (33.9%), and high in 35 (20.5%). Mortality rates were 3.5% in the low-risk group, 15.5% in the moderate group, and 46.4% in the high-risk group (p < 0.001). High RAPID scores were also associated with longer hospital stay median 12 (IQR 9–15) vs. 8 (IQR 6–11) days, p = 0.002.
Conclusion: The RAPID score reliably stratifies pleural infection patients into mortality risk categories, enabling early identification of high-risk cases and timely intervention.
Keywords: Mortality, Pleural infection, Prognosis, RAPID score, Tertiary care.
References
Lehtomäki AI, Nevalainen RM, Toikkanen VJ, Pohja ES, Nieminen JJ, Laurikka JO, et al. Pleural infection - an indicator of morbidity and increased burden on health care. Interact Cardiovasc Thorac Surg. 2020; 31(4): 513–8. DOI: https://doi.org/10.1093/icvts/ivaa147
Lehtomäki A, Nevalainen R, Ukkonen M, Nieminen J, Laurikka J, Khan J. Trends in the incidence, etiology, treatment, and outcomes of pleural infections in adults over a decade in a Finnish University Hospital. Scand J Surg. 2020; 109(2): 127–32. DOI: https://doi.org/10.1177/1457496919832146
Hassan M, Patel S, Sadaka AS, Bedawi EO, Corcoran JP, Porcel JM. Recent insights into the management of pleural infection. Int J Gen Med. 2021; 14: 3415–29. DOI: https://doi.org/10.2147/ijgm.s292705
Xu H, Hu X, Wang W, Chen H, Yu F, Zhang X, et al. Clinical application and evaluation of metagenomic next-generation sequencing in pulmonary infection with pleural effusion. Infect Drug Resist. 2022; 15: 2813–24.
DOI: https://doi.org/10.2147/idr.s365757
Gupta I, Eid SM, Gillaspie EA, Broderick S, Shafiq M. Epidemiologic trends in pleural infection: A nationwide analysis. Ann Am Thorac Soc. 2021; 18(3): 452–9. DOI: https://doi.org/10.1513/annalsats.202001-075oc
Corcoran JP, Psallidas I, Gerry S, Piccolo F, Koegelenberg CF, Saba T, et al. Prospective validation of the RAPID clinical risk prediction score in adult patients with pleural infection: The PILOT study. Eur Respir J. 2020; 56(5): 2000130. DOI: https://doi.org/10.1183/13993003.00130-2020
Sundaralingam A, Banka R, Rahman NM. Management of pleural infection. Pulm Ther. 2021; 7(1): 59–74.
DOI: https://doi.org/10.1007/s41030-020-00140-7
Shiraishi Y, Kryukov K, Tomomatsu K, Sakamaki F, Inoue S, Nakagawa S, et al. Diagnosis of pleural empyema/ parapneumonic effusion by next-generation sequencing. Infect Dis. 2021; 53(6): 450–9. DOI: https://doi.org/10.1080/23744235.2021.1892178
Hassan M, Cargill T, Harriss E, Asciak R, Mercer RM, Bedawi EO, et al. The microbiology of pleural infection in adults: a systematic review. Eur Respir J. 2019; 54(3): 1900542. DOI: https://doi.org/10.1183/13993003.00542-2019
Klausen MB, Laursen C, Bendixen M, Naidu B, Bedawi EO, Rahman NM, et al. Does the time to diagnosis and treatment influence outcome in adults with pleural infections? Eur Clin Respir J. 2023; 10(1): 2174645. DOI: https://doi.org/10.1080/20018525.2023.2174645
Annareddy S Jr, Ghewade B, Jadhav U, Wagh P, Jadhav U. Unraveling the predictive potential of RAPID scoring in pleural infection: A critical review. Cureus. 2023; 15(9): e44515. DOI: https://doi.org/10.7759/cureus.44515
Simon L, Belaroussi Y, Vayssette A, Khalife T, Le Roux M, Debrosse D, et al. Role of RAPID score and surgery in the management of pleural infection: A single center retrospective study. J Thorac Dis. 2023; 15(10): 5340–8.
DOI: https://doi.org/10.21037/jtd-22-1599 s
Liou AA, Anderson B, Whitehurst C, Roman S, Beltran C, Acton T, et al. The role of the RAPID score in surgical planning for empyema. J Thorac Dis. 2023; 15(3): 985-93. DOI: https://doi.org/10.21037/jtd-22-747 s
Rahman NM, Kahan BC, Miller RF, Gleeson FV, Nunn AJ, Maskell NA. A clinical score (RAPID) to identify those at risk for poor outcome at presentation in patients with pleural infection. Chest. 2014; 145(4): 848–55. DOI: https://doi.org/10.1378/chest.13-1558
Kanellakis NI, Wrightson JM, Gerry S, Ilott N, Corcoran JP, Bedawi EO, et al. The bacteriology of pleural infection (TORPIDS): An exploratory metagenomics analysis through next-generation sequencing. Lancet Microbe. 2022; 3(4): e294–302. DOI: https://doi.org/10.1016/s2666-5247(21)00327-x
Bedawi EO, Ricciardi S, Hassan M, Gooseman MR, Asciak R, Castro-Añón O, et al. ERS/ ESTS statement on the management of pleural infection in adults. Eur Respir J. 2023; 61(2): 2201062. DOI: https://doi.org/10.1183/13993003.01062-2022
Stüben BO, Plitzko GA, Urban F, Kölzer H, Kemper M, Wakker J, et al. Adjusting the RAPID score with two additional variables significantly increases its predictive value in patients with empyema. Sci Rep. 2023; 13(1): 3206. DOI: https://doi.org/10.1038/s41598-023-29946-6
Carneiro DC, Duarte D’Ambrosio P, Mariani AW, Fonini JS, Aguirre-García KZ, Carneiro-Leão JP, et al. Evaluation of the RAPID score as a predictor of postoperative morbidity and mortality in patients undergoing pulmonary decortication for stage III pleural empyema. Clinics (Sao Paulo). 2024; 79: 100356. DOI: https://doi.org/10.1016/j.clinsp.2024.100356
Elsheikh A, Bhatnagar M, Rahman NM. Diagnosis and management of pleural infection. Breathe (Sheff). 2023; 19(4): 230146. DOI: https://doi.org/10.1183/20734735.0146-2023
Musher DM. Pleural empyema: Etiology and pathogenesis. Clin Infect Dis. 2024; 79(6): 1533–4. DOI: https://doi.org/10.1093/cid/ciae102
Presti T, Asghar A, Ravikumar N. Management of Pleural Infection: A Historical Review and Updates. Life (Basel). 2024;14(2):10. DOI: 10.3390/life14020010. DOI: https://www.mdpi.com/2673-527X/4/2/10
Otero JA, Mandrekar J, Wolf MJ, Starkey JC, Carmona EM, Dyrhovden R, et al. Pleural-space infection microbiology as assessed using a clinical sequencing-based assay: Common detection of oral commensals and other organisms. 2024; 62(12): e0069424. DOI: https://doi.org/10.1128/jcm.00694-24
Bhatnagar R, Maskell N. Treatment of complicated pleural effusions in 2013. Clin Chest Med. 2013; 34(1): 47–62. DOI: https://doi.org/10.1016/j.ccm.2012.11.004
Atif M, Naseem M, Sarwar S, Mukhtar S, Malik I, Hassan MR, et al. Spectrum of microorganisms, antibiotic resistance pattern, and treatment outcomes among patients with empyema thoracis: a descriptive cross-sectional study from Bahawal Victoria Hospital Bahawalpur, Punjab, Pakistan. Front Med (Lausanne). 2021; 8: 665963. DOI: https://www.frontiersin.org/articles/10.3389/fmed.2021.665963/full
Porcel JM, Light RW. Pleural effusions. Dis Mon. 2013; 59(2): 29–57. DOI: https://doi.org/10.1016/j.disamonth.2012.11.002
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