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Disorders of the Pleura |

Rapid Score for Predicting Pleural Infection Outcomes: A Validation Study

Christopher Henry; Shekhar Ghamande; Alejandro C Arroliga; Heath White, MS
Author and Funding Information

Scott and White Memorial Hospital, Temple, TX


Chest. 2014;146(4_MeetingAbstracts):438A. doi:10.1378/chest.1983105
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Abstract

SESSION TITLE: Pleural Disease Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 29, 2014 at 01:30 PM - 02:30 PM

PURPOSE: Pleural infections are associated with significant morbidity and mortality. Early risk stratification can impact management. The recently developed RAPID score uses five criteria (BUN, Age, Purulence, Hospital-versus-Community acquired, and Albumin) to predict outcomes in pleural infections. Our goal is to validate the RAPID score and identify other factors associated with mortality.

METHODS: We evaluated a single-center retrospective cohort of patients diagnosed with culture positive pleural infection. RAPID scores were grouped into low (0-2), intermediate (3-4) and high risk (5-7). Social security death index (www.genealogybank.com/gbnk/ssdi) was searched to determine the date of death. Logistic regression was used to calculate the odds ratio of mortality at 3 months, 1 year, 3 years, and 5 years. Clinical factors and comorbid conditions were evaluated for association with the three risk groups.

RESULTS: The study included 186 patients. Three month mortality for low, intermediate and high risk groups was 1.5%, 17.8% (OR 14.3; 95% CI=1.82-112.57; p=0.011) and 47.8% (OR 60.49; 95% CI=7.73 - 473.4; p<0.001) respectively. There was a significant difference in mortality at 1, 3 and 5 years among the three risk groups (p<0.0001). Other factors associated with high risk scores include infection with Gram negative rods (p=0.0081), male sex (p=0.005), cancer (p<0.0001), heart disease (p<0.0001) and COPD (p<0.0001).

CONCLUSIONS: The 3 month mortality for each group was similar to the original study by Rahman et al. Unlike the original study, our cohort included patients under 18 years old, those with malignancy, and those with previous surgical intervention, showing the value of the RAPID score in a diverse patient population. Furthermore, we showed that mortality differences among risk groups persisted 5 years after diagnosis and additional factors were identified that may predict a poor prognosis.

CLINICAL IMPLICATIONS: The RAPID score is a useful tool for risk stratifying patients diagnosed with pleural infections and could help guide early management.

DISCLOSURE: The following authors have nothing to disclose: Christopher Henry, Shekhar Ghamande, Alejandro C Arroliga, Heath White

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