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Liou AA, Anderson B, Whitehurst C, Roman S, Beltran C, Acton T, Foster J, Nwokem O, Mogri I, Hammonds K, White HD, Arroliga AC, Ghamande S. The role of the RAPID score in surgical planning for empyema. J Thorac Dis 2023; 15:985-993. [PMID: 37065558 PMCID: PMC10089882 DOI: 10.21037/jtd-22-747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Accepted: 01/06/2023] [Indexed: 02/18/2023]
Abstract
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 A retrospective study of patients with complicated pleural effusions and/or empyema undergoing thoracoscopic or open decortication admitted to multiple affiliated Texas hospitals from September 1, 2014 to September 30, 2018. The primary outcome was all-cause 90-day mortality. The secondary outcomes were organ failure, length of stay and 30-day readmission rate. The outcomes were compared between early surgery (≤3 days from diagnosis) and late surgery (>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.
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Affiliation(s)
- Ashley A. Liou
- Division of Pulmonary, Critical Care and Sleep Medicine, Baylor Scott and White/Texas A&M College of Medicine, Temple, TX, USA
| | - Braden Anderson
- Department of Internal Medicine, Baylor Scott and White/Texas A&M College of Medicine, Temple, TX, USA
| | - Courtney Whitehurst
- Department of Internal Medicine, Baylor Scott and White/Texas A&M College of Medicine, Temple, TX, USA
| | - Sabine Roman
- Department of Internal Medicine, Baylor Scott and White/Texas A&M College of Medicine, Temple, TX, USA
| | - Christian Beltran
- Department of Internal Medicine, Baylor Scott and White/Texas A&M College of Medicine, Temple, TX, USA
| | - Tayler Acton
- Department of Internal Medicine, Baylor Scott and White/Texas A&M College of Medicine, Temple, TX, USA
| | - Jeannine Foster
- Department of Internal Medicine, Baylor University Medical Center, Dallas, TX, USA
| | - Obinna Nwokem
- Department of Internal Medicine, Baylor University Medical Center, Dallas, TX, USA
| | - Idrees Mogri
- Division of Pulmonary and Critical Care, Baylor University Medical Center, Dallas, TX, USA
| | | | - Heath D. White
- Division of Pulmonary, Critical Care and Sleep Medicine, Baylor Scott and White/Texas A&M College of Medicine, Temple, TX, USA
| | - Alejandro C. Arroliga
- Department of Internal Medicine, Baylor Scott and White/Texas A&M College of Medicine, Temple, TX, USA
| | - Shekhar Ghamande
- Division of Pulmonary, Critical Care and Sleep Medicine, Baylor Scott and White/Texas A&M College of Medicine, Temple, TX, USA
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