Abstract
Data on interstitial lung disease (ILD) outcomes in the intensive care unit (ICU) is of limited value due to population heterogeneity. The aim of this study was to examine risk factors for mortality and ILD mortality rates in the ICU.
We performed a systematic review using five databases. 50 studies were identified and 34 were included: 17 studies on various aetiologies of ILD (mixed-ILD) and 17 on idiopathic pulmonary fibrosis (IPF). In mixed-ILD, elevated APACHE score, hypoxaemia and mechanical ventilation are risk factors for mortality. No increased mortality was found with steroid use. Evidence is inconclusive on advanced age. In IPF, evidence is inconclusive for all factors except mechanical ventilation and hypoxaemia. The overall in-hospital mortality was available in 15 studies on mixed-ILD (62% in 2001–2009 and 48% in 2010–2017) and 15 studies on IPF (79% in 1993–2004 and 65% in 2005–2017). Follow-up mortality rate at 1 year ranged between 53% and 100%.
Irrespective of ILD aetiology, mechanical ventilation is associated with increased mortality. For mixed-ILD, hypoxaemia and APACHE scores are also associated with increased mortality. IPF has the highest mortality rate among ILDs, but since 1993 the rate appears to be declining. Despite improving in-hospital survival, overall mortality remains high.
Abstract
Elevated APACHE score, hypoxaemia and mechanical ventilation are risk factors for mortality in ILD. No increased mortality was found with steroid use. Evidence on advanced age is inconclusive. Survival may be improving over time, but still remains high. http://ow.ly/6F1d30mijdy
Footnotes
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Provenance: Submitted article, peer reviewed.
Conflict of interest: J.A. Huapaya has nothing to disclose.
Conflict of interest: E.M. Wilfong has nothing to disclose.
Conflict of interest: C.T. Harden has nothing to disclose.
Conflict of interest: R.G. Brower has nothing to disclose.
Conflict of interest: S.K. Danoff has nothing to disclose.
Support statement: This study was supported by the Lisa Sandler Spaeth Fund for Pulmonary Fibrosis. The sponsor had no role on the conception of this work.
- Received July 8, 2018.
- Accepted October 5, 2018.
- Copyright ©ERS 2018.
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