What translational research was done? 

We collaborated with Public Health England to explore the relationship between pleural infection and flu. We showed that pleural infection is becoming more common, particularly in elderly people who might not be fit enough for surgery. 

Combining the data with patient focus group discussions, we demonstrated a clear need for a validated score to predict the patient’s risk of dying and avoid surgery if possible. This will be used when a patient is admitted to hospital and their treatment is being planned. 

We developed and validated the RAPID score for predicting the chance of someone dying with pleural infection when admitted to hospital, to inform the patient’s care. To further personalise care, we explored biomarkers in pleural fluid samples from our Pleural Investigation Cohort, the world's largest collection. 

We showed that the biomarker suPAR could improve both diagnosis of pleural infection and predict the need for surgery. 

We led an early phase trial to develop therapy options for patients not having surgery. This looked at using saline to wash out the pleural space (irrigation) in patients with ongoing accumulations of fluid and blood poisoning, despite tube drainage. This showed that saline irrigation was safe and effective without the risk of bleeding. 

Translation into later phase research, clinical practice and patient benefit 

The RAPID score was further validated in a national study and incorporated into the British Thoracic Society (BTS) guidelines. It’s now used regularly in NHS hospitals across the UK. 

Based on our trial, saline irrigation was adopted in clinical practice for patients where fibrinolytic therapy (to prevent blood clots) or surgery weren’t suitable. A new BTS guideline will recommend its use in this setting. We are planning a larger phase three trial to evaluate its full impact. 

The biomarker suPAR is being examined in a study of different groups over a long period, to predict patients needing therapies such as fibrinolytics or surgery. 

These advances led to updates to national and international guidelines and improved prediction, patient choice and personalised care in pleural infection. 

References 

1.      Rahman et al., Chest, 2014;DOI:10.1378/chest.13-1558

2.      Arnold et al., AJRCCM, 2020;DOI:10.1164/rccm.201911-2169OC 

3.      Hooper et al., ERJ, 2015;DOI:10.1183/09031936.00147214