Causes of acute respiratory hospitalizations predict survival in fibrosing interstitial lung diseases

Abstract

Background Acute exacerbation of ILD (AE-ILD) is a common reason for hospitalization; it is also associated with significant mortality. Less is known about the prognostic significance of other events causing acute, non-elective hospitalizations in ILD patients. Methods ILD patients hospitalized due to acute respiratory worsening were collected from medical records. Reasons for respiratory deterioration were classified into AE-ILDs and other causes. Clinical features and survival data of idiopathic pulmonary fibrosis (IPF) and other types of ILDs were evaluated and compared. Results In all, 237 patients (138 with IPF and 99 with other ILD) fulfilled the inclusion criteria. Of the non-IPF ILD types, the most prevalent subgroups were connective tissue disease-associated ILD (n = 33) and asbestosis (n = 22). The most common cause for hospitalization was AE-ILD explaining 41% of hospitalizations. Lower respiratory tract infection (22%), subacute progression of ILD (12%) and cardiovascular causes (7.2%) were other common reasons for hospital treatment. Patients with a lower respiratory tract infection had a more favorable prognosis compared with patients with AE-ILD. AE-ILDs were less fatal than cardiovascular or concurrent non-ILD-related causes for hospitalizations in non-IPF patients. High Gender-Age-Physiology (GAP) index was a marker for shortened survival and earlier AE-ILDs in all patients. IPF patients had a significantly shorter overall and post-hospitalization survival time compared with other ILDs. Conclusions Most respiratory hospitalizations in ILD patients were related to causes other than AE-ILD, which highlights the importance of accurate differential diagnosis in order to target the appropriate treatment for each ILD patient.

Use of illness severity scores to predict mortality in interstitial lung disease patients hospitalised with acute respiratory deterioration

“…As reported before the emergence of SARS-CoV-2, patients hospitalised with ARD-IPF had a poor prognosis. 4,[23][24][25] The median survival in this cohort was 23 days, slightly shorter than the survival times in the literature ranging between 1 and 4 months after AE-IPF. [26][27][28][29] Whilst in-hospital and 90-day mortality rates were significantly higher in the IPF group than the non-IPF group, all admissions related to an ARD were associated with significant mortality; 24% and 38% for 30-and 90-day mortality, respectively.…”

The Significance of Implementing Bilevel Positive Airway Pressure under Cluster Nursing in Improving the Survival Possibility of Patients with Severe Pulmonary Infection Complicated by Respiratory Failure

“…Endotoxin produced by pathogens can stimulate immune cells to release massive inflammatory factors, leading to endothelial cell adhesion and neutrophil proliferation, during which proteases are released in large quantities, causing damage to vascular endothelial cells and epithelial cells, and finally causing pulmonary fibrosis and microthrombosis [26,27]. Therefore, the level of IFs in the body is of great In this research, TNF-α, IL-6, PCT, and WBC were reduced statistically in all the three groups after treatment, with lower levels in groups A and C compared with group B, indicating that BIPAP was better than conventional mechanical ventilation in alleviating patients' inflammatory responses, which was consistent with past literature [28,29].…”