In-Hospital Mortality in Patients with Idiopathic Pulmonary Fibrosis: A US Cohort Study

Abstract

PurposeIn patients with idiopathic pulmonary fibrosis (IPF), hospitalizations are associated with high mortality. We sought to determine in-hospital mortality rates and factors associated with in-hospital mortality in patients with IPF.MethodsPatients with IPF were identified from the Premier Healthcare Database, a representative administrative dataset that includes > 20% of hospital discharges in the US, using an algorithm based on diagnostic codes and billing data. We used logistic regression to analyze associations between patient-, hospital-, and treatment-related characteristics and a composite primary outcome of death during the index visit, lung transplant during the index visit and > 1 day after admission, or death during a readmission within 90 days.ResultsThe cohort comprised 6665 patients with IPF hospitalized between October 2011 and October 2014. A total of 963 (14.4%) met the primary outcome. Factors significantly associated with a higher risk of the primary outcome included mechanical ventilation [odds ratio 4.65 (95% CI 3.73, 5.80)], admission to the intensive care unit [1.83 (1.52, 2.21)], treatment with opioids (3.06 [2.57, 3.65]), and a diagnosis of pneumonia [1.44 (1.21, 1.71)]. Factors significantly associated with a lower risk included concurrent chronic obstructive pulmonary disease [0.65 (0.55, 0.77)] and female sex [0.67 (0.57, 0.79)].ConclusionsPatients with IPF, particularly those receiving mechanical ventilation or intensive care, are at substantial risk of death or lung transplant during hospitalization or death during a readmission within 90 days.Electronic supplementary materialThe online version of this article (10.1007/s00408-019-00270-z) contains supplementary material, which is available to authorized users.

In-hospital mortality trends among patients with idiopathic pulmonary fibrosis in the United States between 2013-2017: a comparison of academic and non-academic programs.

“…[35] The in uence of comorbid conditions and interventions on IPF mortality has been increasingly studied over the last decade. [23] Our study supports the ndings of others who have shown age, sex [30,[36][37][38], race and smoking history [36,37,39] to confer differential mortality risk. We found that admission to an academic center was associated with higher mortality risk, which is similar to previous studies [34] and may re ect a higher acuity of illness.…”

“…These ndings are supported by others using the NIS dataset, who reported similar all-cause mortality in patients with IPF admitted to the hospital 2006 to 2012 [29] and others using a similar dataset, who reported IPF mortality during index admission from 2011 and 2014 to be 10.3%. [30] These ndings stand in contrast to those published using the online CDC national death certi cate database, which showed IPF-related mortality to be increasing over this timeframe. [31,32] Besides, others reported decline in IPF all-cause mortality and hospitalizations using NIS dataset.…”

“…Respiratory failure and need for mechanical ventilation therapy were the strongest predictors of in-hospital mortality, which supports prior ndings. [7,30] It is unclear why elective admission has been associated with increased mortality. One theory would be that elective admissions might be related to referrals from non-academic hospitals or urgent admissions from the outpatient clinic.…”

Prognosis and causes of death of patients with acute exacerbation of fibrosing interstitial lung diseases

“…[6][7][8] The studies mentioned above, however, did not use the current definition of AE-IPF in their inclusion criteria, and in addition, one study included patients treated in the ICU, 8 which is known to be a risk factor for death, at least in patients with IPF. 28 The other published studies concerning AE-FILD have been conducted in Japan, [9][10][11][12][13][14] of which only one demonstrated longer survival of patients with non-IPF compared with that of IPF 13 ; in another study, the prognosis of AE-IPF compared with other FILDs was even better. 9 Altogether, it can be stated that the earlier publications focusing on acute respiratory worsening or AE of IPF or non-IPF FILDs have consisted of small and heterogenic study populations with variable inclusion criteria, which complicate making comparisons between the investigations.…”

ERS International Congress, Madrid, 2019: highlights from the Respiratory Intensive Care Assembly

“…Improving outcomes in interstitial lung disease patients mechanically ventilated in the ICU Alexandre Demoule focused on outcomes and treatment strategies for interstitial lung disease (ILD) patients in the ICU. "We can only improve" was the take home message as the mortality of ILD patients exceeds 50% [97], with mechanical ventilation as a primary risk factor [98]. NIV and HFNC are scarcely explored and should not delay intubation.…”