The role of the RAPID score in surgical planning for empyema

Journal of Thoracic Disease

article

Ashley A. Liou¹  Braden Anderson²  Courtney Whitehurst²  Sabine Roman²  Christian Beltran²  Tayler Acton²  Jeannine Foster³  Obinna Nwokem³  Idrees Mogri⁴  Kendall Hammonds⁵  Heath D. White¹  Alejandro C. Arroliga²  Shekhar Ghamande¹ 

[1] Division of Pulmonary, Critical Care and Sleep Medicine, Baylor Scott and White/Texas A&M College of Medicine;Department of Internal Medicine, Baylor Scott and White/Texas A&M College of Medicine;Department of Internal Medicine, Baylor University Medical Center;Division of Pulmonary and Critical Care, Baylor University Medical Center;Baylor Scott & White Research Institute

关键词: Thoracoscopy;    empyema;    pleural effusion;    decortication;    RAPID;   

DOI  :  10.21037/jtd-22-747

学科分类：呼吸医学

来源: Pioneer Bioscience Publishing Company

【 摘 要 】

Background: The RAPID [Renal (urea), Age, fluid Purulence, Infection source, Dietary (albumin)] score is a validated scoring system which allows risk stratification in patients with pleural infection at presentation. Surgical intervention plays a key role in managing pleural empyema. Methods: 3 days from diagnosis) and low [0–3] vs. high [4–7] RAPID scores. Results: We enrolled 182 patients. Late surgery was associated with increased organ failure (64.0% vs. 45.6%, P=0.0197) and longer length of stay (16 vs. 10 days, P<0.0001). High RAPID scores were associated with a higher 90-day mortality (16.3% vs. 2.3%, P=0.0014), and organ failure (81.6% vs. 49.6%, P=0.0001). High RAPID scores with early surgery were associated with higher 90-day mortality (21.4% vs. 0%, P=0.0124), organ failure (78.6% vs. 34.9%, P=0.0044), 30-day readmission (50.0% vs. 16.3%, P=0.027) and length of stay (16 vs. 9 days, P=0.0064). High vs. low RAPID scores with late surgery was associated with a higher rate of organ failure (82.9% vs. 56.7%, P=0.0062), but there was not a significant association with mortality. Conclusions: We found a significant association between RAPID scores and surgical timing with new organ failure. Patients with complicated pleural effusions who had early surgery and low RAPID scores experienced better outcomes including decreased length of stay and organ failure compared with those who had late surgery and low RAPID scores. This suggests that using the RAPID score may help identify those who would benefit from early surgery.

【 授权许可】

Unknown