Abishek Ravichandran¹, Saka Vinod Kumar^1,, Manju R¹, Rakhi Biswas², Sharbari Basu³

Background: Empyema is a serious pleural infection with significant morbidity and mortality. The RAPID score is a validated tool for early risk stratification. This study aimed to evaluate the prognostic value of the RAPID score in adult empyema patients in a tertiary care setting. Methods: A prospective observational study was conducted on 61 adult patients with confirmed empyema. RAPID scores were assigned at admission to stratify patients into low (0–2), medium (3–4), and high (5–7) risk groups. Clinical features, microbiological profile, radiological findings, need for surgery, hospital stay, and 3-month mortality were recorded and analysed. Results:Most patients were male (82%) and aged <50 years (52.5%). Diabetes (42.6%) and tuberculosis (26.2%) were prevalent; Pseudomonas aeruginosa (19.7%) was the most common isolate. RAPID scores classified 65.6% as low risk, 29.5% as medium, and 4.9% as high. Unadjusted analysis showed higher mortality in medium-risk vs. low-risk groups (27.8% vs. 5%; p = 0.026), with no deaths in the high-risk group. On multivariable logistic regression, medium risk had higher but non-significant odds of mortality (aOR 8.03; 95% CI 0.61–105.13; p = 0.112); subgroup analysis suggested a stronger association in non-TB empyema (aOR 13.67; p = 0.061). Only age was independently associated with mortality (p = 0.014). RAPID score was not associated with hospital stay or surgical intervention. Conclusion: The RAPID score is a useful bedside tool for predicting short-term mortality in empyema, particularly in medium-risk patients, though it does not predict hospital stay or surgical need. Age was the strongest individual predictor of mortality.

Empyema, RAPID score, Pleural infection, Mortality prediction, Surgical intervention