Role of RAPID score and adjusted RAPID score in management of infected pleural effusion

Background
Renal (urea), age, fluid purulence, infection source, dietary (albumin) (RAPID) score offers risk stratification for individuals who present with pleural infection. Research is still needed to detect the role of the RAPID score in the success of medical therapy, despite its usage in risk classification and surgical intervention success.


Aim
To assess the role of RAPID score in the detection of successful medical treatment of pleural infection without the need for surgical intervention.


Patients and methods
An analytical retrospective cross–sectional study for patients diagnosed with infected pleural effusion, both sexes aged above 21 years from those attending Cairo University hospitals, Department of Chest Diseases were included in this study after exclusion of the presence of frank pus, positive gram stain or culture and potential of hydrogen less than 7.2.


Results
There were 28 patients and 16 patients with RAPID scores (0,1), respectively, did not need drain insertion (100%), but there were five patients and one patient with RAPID score (3,4) correspondingly all of them needed tube insertion (100%). There were 20 patients with RAPID score 2, medical treatment was succeeded in 12 (60%) patients while medical treatment was failed in eight (40%) patients and they needed tube insertion. There was a statistical relation with RAPID score and the success or failure of medical treatment in patients with infected pleural effusion. Diabetes mellitus (DM) was a predisposing factor for treatment failure at the cut-off value of RAPID score greater than or equal to 2, so the modified RAPID score had more value in the prediction of the outcome of medical treatment in infected pleural effusion.


Conclusion
RAPID score had a predictive role in the management of infected pleural effusion. DM was a predisposing factor for treatment failure and adjusting the RAPID score by including comorbidities as DM and using a modified RAPID score had more value in the prediction of the outcome of medical treatment in infected pleural effusion.