Risk Scores in Pleural Infection – Comprehensive Review Article

Abstract Purpose of Review Pleural infection is associated with high morbidity and mortality rates. Approximately 30% of patients fail treatment, and either die or require surgery. Accurate risk stratification is crucial to identify patients at risk of poor outcomes and to guide timely intervention. This review evaluates validated risk scores in pleural infection and highlights emerging prognostic tools. Recent Findings The RAPID risk score, a validated prognostic risk model in pleural infection, stratifies patients into low, intermediate and high-risk groups, with associated 3-month all-cause mortality of ~ 3%, 9%, and 31% respectively. It also predicts hospital stay, requirement for escalation of treatment (Intrapleural Enzyme Therapy and surgery), and hospital costs. Emerging pleural fluid biomarkers such as Plasminogen Activator Inhibitor-1 (PAI-1) and soluble urokinase Plasminogen Activator Receptor (suPAR) have shown potential prognostic value. Elevated PAI-1 levels have been associated with prolonged hospital stay and increased 12-month mortality rate, whereas high suPAR has been correlated with the need for treatment escalation. Furthermore, pleural fluid microbiology and sonographic findings of septations have shown association with adverse clinical outcomes. Summary The RAPID risk score is the most reliable and validated framework for clinical risk stratification in pleural infection. Future research should evaluate its integration into decision-making for treatment to optimise patient outcomes and reduce healthcare costs. Future models incorporating biomarkers, imaging, and microbiology may increase the prognostic value and clinical utility but will require prospective evaluation.