Chest
Original Research: Disorders of the PleuraA Clinical Score (RAPID) to Identify Those at Risk for Poor Outcome at Presentation in Patients With Pleural Infection
Section snippets
Materials and Methods
This study used data from two randomized trials of intrapleural agents for the treatment of pleural infection10, 28 diagnosed according to identical and standard clinical criteria (described here). The initial model derivation was conducted using baseline clinical and outcome data from the first Multicenter Intrapleural Sepsis Trial (MIST1) (ISRCTN39138989),10 a placebo-controlled randomized trial assessing the use of intrapleural streptokinase that recruited 454 patients from 54 UK centers
Patients and Data Completeness
The trial flowchart combining patients from both studies is presented in Figure 1. The baseline demographic, clinical, and microbiologic characteristics of participants in the combined trial populations and degree of data completeness for the purpose of this study are presented in Table 1. Mortality at 3-month data (primary outcome) were available in 617 of 621 patients (99%), and secondary outcomes (surgery at 3 months and hospital stay from randomization) were available in 614 of 621 patients
Discussion
To our knowledge, this is the first prognostic risk model for patients with pleural infection derived from data obtained from one cohort that has then been validated in a second cohort. Of 22 baseline characteristics recorded at the time of initial presentation, five were strongly independently associated with poor outcome.
The risk model developed gave more weighting to both age and urea in light of their high ORs for mortality, with the other three variables scoring the same. Each patient's
Acknowledgments
Author contributions: Dr Rahman is guarantor for the entire manuscript.
Dr Rahman: contributed to study conception and design, writing and revision of the manuscript, and approval of the submitted version of the manuscript.
Mr Kahan: contributed to conducting the statistical analysis, writing and revision of the manuscript, and approval of the submitted version of the manuscript.
Prof Miller: contributed to the writing and revision of the manuscript and approval of the submitted version of the
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Funding/Support: Drs Rahman and Gleeson are funded by the UK NIHR Oxford Biomedical Research Centre Programme. Dr Maskell is funded by a Clinical Senior Lectureship Higher Education Funding Council for England/United Kingdom Clinical Research Collaboration award.
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