A clinical score (RAPID) to identify those at risk for poor outcome at presentation in patients with pleural infection.
BACKGROUND: Pleural infection is associated with a high morbidity and mortality. Development of a validated clinical risk score at presentation to identify those at high risk of dying would enable patient triage and may help formulate early management strategies. METHODS: A clinical risk score was d...
| Main Authors: | , , , , , |
|---|---|
| Format: | Journal article |
| Language: | English |
| Published: |
American College of Chest Physicians
2014
|
| _version_ | 1797100341524692992 |
|---|---|
| author | Rahman, N Kahan, B Miller, R Gleeson, F Nunn, A Maskell, N |
| author_facet | Rahman, N Kahan, B Miller, R Gleeson, F Nunn, A Maskell, N |
| author_sort | Rahman, N |
| collection | OXFORD |
| description | BACKGROUND: Pleural infection is associated with a high morbidity and mortality. Development of a validated clinical risk score at presentation to identify those at high risk of dying would enable patient triage and may help formulate early management strategies. METHODS: A clinical risk score was derived based on data from patients entering the multicenter UK pleural infection trial (first Multicenter Intrapleural Sepsis Trial [MIST1], n=411). From 22 baseline clinical characteristics, model selection was undertaken to find variables predictive of poor clinical outcome. Outcomes were mortality at 3 months (primary), need for surgical intervention at 3 months, and time from randomization to discharge. The derived scoring system RAPID (renal, age, purulence, infection source, and dietary factors) was validated using patients enrolled in the subsequent MIST2 trial (n=191). RESULTS: Age, urea, albumin, hospital-acquired infection, and nonpurulence predicted poor outcome. Patients were stratified into low-risk (0-2), medium-risk (3-4), and high-risk (5-7) groups. Using the low-risk group as a reference, a RAPID score of 3 to 4 and >4 was associated with an OR of 24.4 (95% CI, 3.1-186.7; P=.002) and 192.4 (95% CI, 25.0-1480.4; P<.001), respectively, for death at 3 months. In the validation cohort (MIST2), a medium-risk RAPID score was nonsignificantly associated with mortality (OR, 3.2; 95% CI, 0.8-13.2; P=.11), and a high-risk score was associated with increased mortality (OR, 14.1; 95% CI, 3.5-56.8; P<.001). Hospitalization duration was associated with increasing RAPID score (score 0-2: median duration=7, interquartile range 6-13; score>5: median duration=15, interquartile range 9-28, P=.08). CONCLUSIONS: The RAPID score may permit risk stratification of patients with pleural infection at presentation. |
| first_indexed | 2024-03-07T05:36:06Z |
| format | Journal article |
| id | oxford-uuid:e3f26666-be83-49b7-adc2-b282d034fecb |
| institution | University of Oxford |
| language | English |
| last_indexed | 2024-03-07T05:36:06Z |
| publishDate | 2014 |
| publisher | American College of Chest Physicians |
| record_format | dspace |
| spelling | oxford-uuid:e3f26666-be83-49b7-adc2-b282d034fecb2022-03-27T10:12:53ZA clinical score (RAPID) to identify those at risk for poor outcome at presentation in patients with pleural infection.Journal articlehttp://purl.org/coar/resource_type/c_dcae04bcuuid:e3f26666-be83-49b7-adc2-b282d034fecbEnglishSymplectic Elements at OxfordAmerican College of Chest Physicians2014Rahman, NKahan, BMiller, RGleeson, FNunn, AMaskell, NBACKGROUND: Pleural infection is associated with a high morbidity and mortality. Development of a validated clinical risk score at presentation to identify those at high risk of dying would enable patient triage and may help formulate early management strategies. METHODS: A clinical risk score was derived based on data from patients entering the multicenter UK pleural infection trial (first Multicenter Intrapleural Sepsis Trial [MIST1], n=411). From 22 baseline clinical characteristics, model selection was undertaken to find variables predictive of poor clinical outcome. Outcomes were mortality at 3 months (primary), need for surgical intervention at 3 months, and time from randomization to discharge. The derived scoring system RAPID (renal, age, purulence, infection source, and dietary factors) was validated using patients enrolled in the subsequent MIST2 trial (n=191). RESULTS: Age, urea, albumin, hospital-acquired infection, and nonpurulence predicted poor outcome. Patients were stratified into low-risk (0-2), medium-risk (3-4), and high-risk (5-7) groups. Using the low-risk group as a reference, a RAPID score of 3 to 4 and >4 was associated with an OR of 24.4 (95% CI, 3.1-186.7; P=.002) and 192.4 (95% CI, 25.0-1480.4; P<.001), respectively, for death at 3 months. In the validation cohort (MIST2), a medium-risk RAPID score was nonsignificantly associated with mortality (OR, 3.2; 95% CI, 0.8-13.2; P=.11), and a high-risk score was associated with increased mortality (OR, 14.1; 95% CI, 3.5-56.8; P<.001). Hospitalization duration was associated with increasing RAPID score (score 0-2: median duration=7, interquartile range 6-13; score>5: median duration=15, interquartile range 9-28, P=.08). CONCLUSIONS: The RAPID score may permit risk stratification of patients with pleural infection at presentation. |
| spellingShingle | Rahman, N Kahan, B Miller, R Gleeson, F Nunn, A Maskell, N A clinical score (RAPID) to identify those at risk for poor outcome at presentation in patients with pleural infection. |
| title | A clinical score (RAPID) to identify those at risk for poor outcome at presentation in patients with pleural infection. |
| title_full | A clinical score (RAPID) to identify those at risk for poor outcome at presentation in patients with pleural infection. |
| title_fullStr | A clinical score (RAPID) to identify those at risk for poor outcome at presentation in patients with pleural infection. |
| title_full_unstemmed | A clinical score (RAPID) to identify those at risk for poor outcome at presentation in patients with pleural infection. |
| title_short | A clinical score (RAPID) to identify those at risk for poor outcome at presentation in patients with pleural infection. |
| title_sort | clinical score rapid to identify those at risk for poor outcome at presentation in patients with pleural infection |
| work_keys_str_mv | AT rahmann aclinicalscorerapidtoidentifythoseatriskforpooroutcomeatpresentationinpatientswithpleuralinfection AT kahanb aclinicalscorerapidtoidentifythoseatriskforpooroutcomeatpresentationinpatientswithpleuralinfection AT millerr aclinicalscorerapidtoidentifythoseatriskforpooroutcomeatpresentationinpatientswithpleuralinfection AT gleesonf aclinicalscorerapidtoidentifythoseatriskforpooroutcomeatpresentationinpatientswithpleuralinfection AT nunna aclinicalscorerapidtoidentifythoseatriskforpooroutcomeatpresentationinpatientswithpleuralinfection AT maskelln aclinicalscorerapidtoidentifythoseatriskforpooroutcomeatpresentationinpatientswithpleuralinfection AT rahmann clinicalscorerapidtoidentifythoseatriskforpooroutcomeatpresentationinpatientswithpleuralinfection AT kahanb clinicalscorerapidtoidentifythoseatriskforpooroutcomeatpresentationinpatientswithpleuralinfection AT millerr clinicalscorerapidtoidentifythoseatriskforpooroutcomeatpresentationinpatientswithpleuralinfection AT gleesonf clinicalscorerapidtoidentifythoseatriskforpooroutcomeatpresentationinpatientswithpleuralinfection AT nunna clinicalscorerapidtoidentifythoseatriskforpooroutcomeatpresentationinpatientswithpleuralinfection AT maskelln clinicalscorerapidtoidentifythoseatriskforpooroutcomeatpresentationinpatientswithpleuralinfection |