Does the sonographic presence and severity of pleural fluid septation have an impact on clinical outcomes in pleural infection? - Data from the Pleural Infection Longitudinal Outcome Study (PILOT)

Background: Pleural infection is common and associated with significant morbidity and mortality. Previous retrospective data have suggested the sonographic presence of pleural fluid septation at diagnosis may be a prognostic indicator [1]. Method The Pleural Infection Longitudinal Outcome Study (PILOT) was a multinational prospective observational cohort study (n = 551 patients) powered to validate a previously described clinical risk score (RAPID) [2]. The primary outcome was 3-month mortality from pleural infection. Secondary outcomes included surgical referral; failure of initial medical therapy; and length of hospital stay. Data collected included the sonographic extent of pleural fluid septation at diagnosis, as determined by the responsible clinician sonographer. The study was funded by the UK Medical Research Council, and registered with ClinicalTrials.gov (ISRCTN 50236700). Results: The presence of pleural fluid septation did not have a significant impact on the study’s primary outcome (figure 1); although it did reduce the performance of the clinical risk score. Conclusion: Pleural fluid septation does not have an independent impact on mortality from pleural infection, although it may have an influence on other relevant clinical outcomes. References 1. Ultrasound Med Biol 2009; 35(9):1468-74 2. Chest 2014; 145(4):848-55