title: Predicting Long-Term Outcomes in Pleural Infections. RAPID Score for Risk Stratification.
abstract: BACKGROUND
  Pleural infections are associated with significant morbidity and mortality. The recently developed RAPID (renal, age, purulence, infection source, and dietary factors) score consists of five clinical factors that can identify patients at risk for increased mortality.
  
  
  OBJECTIVE
  The objective of this study was to further validate the RAPID score in a diverse cohort, identify factors associated with mortality, and provide long-term outcomes.
  
  
  METHODS
  We evaluated a single-center retrospective cohort of 187 patients with culture-positive pleural infections. Patients were classified by RAPID scores into low-risk (0-2), medium-risk (3-4), and high-risk (5-7) groups. The Social Security Death Index was used to determine date of death. All-cause mortality was assessed at 3 months, 1 year, 3 years, and 5 years. Clinical factors and comorbid conditions were evaluated for association.
  
  
  RESULTS
  Three-month mortality for low-, medium-, and high-risk groups was 1.5, 17.8, and 47.8%, respectively. Increased odds were observed among medium-risk (odds ratio, 14.3; 95% confidence interval, 1.8-112.6; P = 0.01) and high-risk groups (odds ratio, 53.3; 95% confidence interval, 6.8-416.8; P < 0.01). This trend continued at 1, 3, and 5 years. Factors associated with high-risk scores include gram-negative rod infections, heart disease, diabetes, cancer, lung disease, and increased length of stay.
  
  
  CONCLUSIONS
  When applied to a diverse patient cohort, the RAPID score predicts outcomes in patients up to 5 years and may aid in long-term risk stratification on presentation.
authors.affiliation: 1 Division of Pulmonary, Critical Care and Sleep Medicine.
authors.forename: Heath D
authors.initials: HD
authors.lastname: White
authors.affiliation: 2 Internal Medicine Residency Program, and.
authors.forename: Christopher
authors.initials: C
authors.lastname: Henry
authors.affiliation: 3 Center for Applied Health Research, Baylor Scott & White Health, Temple, Texas.
authors.forename: Eileen M
authors.initials: EM
authors.lastname: Stock
authors.affiliation: 1 Division of Pulmonary, Critical Care and Sleep Medicine.
authors.forename: Alejandro C
authors.initials: AC
authors.lastname: Arroliga
authors.affiliation: 1 Division of Pulmonary, Critical Care and Sleep Medicine.
authors.forename: Shekhar
authors.initials: S
authors.lastname: Ghamande
mesh_terms: D000368:Aged; D019468:Disease Management; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010998:Pleurisy / Q000209:etiology / Q000401:mortality* / Q000628:therapy; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment / Q000592:standards*; D012720:Severity of Illness Index; D062606:Tertiary Care Centers; D013995:Time
keywords: RAPID score; disease management; empyema; long-term outcomes; pleural disease