Chest
Volume 149, Issue 5, May 2016, Pages 1205-1214
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Original Research: Diffuse Lung Disease
Patients With Fibrotic Interstitial Lung Disease Hospitalized for Acute Respiratory Worsening: A Large Cohort Analysis

https://doi.org/10.1016/j.chest.2015.12.026Get rights and content

Background

Acute respiratory worsening (ARW) requiring hospitalization in patients with fibrotic interstitial lung disease (f-ILD) is common. Little is known about the frequency and implications of ARW in IPF and non-IPF ILD patients hospitalized for acute exacerbation (AE) vs known causes of ARW.

Methods

All consecutive patients with f-ILD hospitalized with ARW at our institution from 2000 to 2014 were reviewed. ARW was defined as any worsening of respiratory symptoms with new or worsened hypoxemia or hypercapnia within 30 days of admission. Suspected AE was defined using modified 2007 American Thoracic Society/European Respiratory Society criteria. Known causes of ARW were reviewed and collated along with in-hospital and all-cause mortality postdischarge.

Results

A total of 220 patients (100 with IPF and 120 non-IPF) composed 311 admissions for ARW. Suspected AE (SAE) comprised 52% of ARW admissions, followed by infection (20%), and subacute progression of disease (15%). In-hospital mortality was similar in patients with IPF vs patients without (55 vs 45%, P = .18), but worse in suspected AE admission types (OR, 3.1 [1.9-5.14]). One-year survival after last ARW admission for the whole cohort was 22%, despite only 27% of patients presenting with baseline oxygen requirement at admission and a mean admission Charlson Comorbidity Index score of 5.4 (expected 1-year survival, 89%). Survival after discharge was similar between SAE and secondary ARW admission types in both IPF and non-IPF patients.

Conclusions

Among patients with f-ILD, hospitalization for ARW appears associated with significant in-hospital and postdischarge mortality regardless of underlying fibrotic lung disease or non-AE cause of acute respiratory decline.

Section snippets

Definitions of Fibrotic Lung Disease and Patient Characteristics

Mayo Clinic Institutional Review Board approval was obtained (#12-010133). A search of the electronic medical records from January 1, 2000, to December 31, 2014, was performed for consecutive patients with suspected or known lung fibrosis and hospital admission for ARW using the search terms “lung fibrosis” and “acute respiratory failure.” Each admission was reassessed by study members for IPF diagnosis as defined by recent international criteria.12 Non-IPF cases were further categorized

Study Population

Two hundred and sixty-six patients were identified in the initial cohort, with 220 meeting inclusion criteria. These patients accounted for 311 unique ARW admissions. Population demographics are presented in Table 1. IPF accounted for 46% of presenting fibrotic lung disease followed by connective tissue disease-interstitial lung disease (CTD-ILD) (25%). Nearly one-third of patients (29%) presented without prior f-ILD diagnosis at the time of admission. Among previously diagnosed patients with

Discussion

Important findings from our study suggest that hospitalizations for ARW occur frequently in both patients with IPF and non-IPF fibrotic lung disease patients; in fact, patients without IPF accounted for the majority of consecutive patients with f-ILD admitted with ARW (54%) and 61% of all unique ARW admissions. Although a large-scale, single-center retrospective study, ours is the first to our knowledge to systematically review consecutive ARW admissions in a US-based population comparing f-ILD

Acknowledgments

Author contributions: All authors contributed to the conception, design, abstraction, and analysis of data, as well as writing of this manuscript. T.M. and K.G.L. are identified as guarantors of this manuscript.

Financial/nonfinancial disclosures: The authors have reported to CHEST the following: T.M. is the recipient of a Mayo Clinic intramural career development award, the Brewer Award for Research in Idiopathic Pulmonary Fibrosis, which partially funded research time to complete this

References (19)

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