Weight Loss as a Predictor of Mortality in Patients with Interstitial Lung Disease

Pugashetti, Janelle Vu; Graham, Julia; Boctor, Noelle; Méndez, Clyo Anahi Chávez; Foster, Erina N.; Juárez, Maria; Harper, Richart W; Morrissey, Brian M.; Kadoch, Michel; Oldham, J.

doi:10.1164/ajrccm-conference.2019.199.1_meetingabstracts.a3386

Cited by 12 publications

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“…One theory would be that elective admissions might be related to referrals from non-academic hospitals or urgent admissions from the outpatient clinic. In our assessment of comorbid conditions, our ndings supported the work of other showing mortality risk to be increased in patients with pneumonia, [34,40] low body mass index, [41] and thromboembolic disease, [42]. We found that those with concurrent obesity, GERD, diabetes and sleep apnea had lower mortality risk, which adds to mixed results with these conditions.…”

Section: Discussionsupporting

confidence: 87%

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.

Alqalyoobi

Pérez

Oldham

2020

Preprint

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BackgroundIdiopathic pulmonary fibrosis (IPF) is a devastating condition characterized by progressive lung function decline and early mortality. While early accurate diagnosis is essential for IPF treatment, data evaluating the impact of hospital academic status on IPF-related mortality remains limited. Here we examined in-hospital mortality trends for patients with IPF from 2013-2017. We hypothesized that in-hospital IPF mortality would be influenced by hospital academic setting.MethodsHospitalization data was extracted from the National Inpatient Sample (NIS) for subjects with an international classification of disease code for IPF. In-hospital mortality stratified by hospital setting (academic versus non-academic) was the primary outcome of interest, with secondary analyses performed for subgroups with and without respiratory failure and requiring mechanical ventilation. Predictors of mortality were then assessed.ResultsAmong 93,680 patients with IPF requiring hospitalization, 58,450 (62.4%) were admitted to academic institutions. In-hospital mortality decreased significantly in those admitted to an academic hospital (p<0.001) but remained unchanged in patients admitted to a non-academic hospital. A plateau in-hospital mortality was observed among all hospitalized patients (p=0.12), with a significant decrease observed for patients with admitted respiratory failure (p<0.001) and those placed on mechanic ventilation (p<0.001).ConclusionIn-hospital mortality decreased significantly for patients with IPF admitted to an academic hospital, suggesting that management strategies may differ by hospital setting. Mortality among those with respiratory failure and those requiring mechanical ventilation has dropped significantly. Our findings underscore the importance of promoting early referral to an academic institution and adherence to international treatment guidelines.

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Section: Discussionsupporting

confidence: 87%

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.

Alqalyoobi

Pérez

Oldham

2020

Preprint

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“…There have been conflicting data on the impact BMI has on survival in ILD. While some studies have shown an increased risk of acute ILD exacerbations with higher BMI [20], others have shown no association of BMI with survival or even an improved survival in patients with a higher baseline BMI [21,22]. Therefore, although obesity is a risk factor for OSA [23], it is unclear whether an increased BMI impacts disease progression and survival in patients with ILD.…”

Section: Discussionmentioning

confidence: 99%

A cluster-based analysis evaluating the impact of comorbidities in fibrotic interstitial lung disease

et al. 2020

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Background Comorbidities are frequent and have been associated with poor quality of life, increased hospitalizations, and mortality in patients with interstitial lung disease (ILD). However, it is unclear how comorbidities lead to these negative outcomes and whether they could influence ILD disease progression. The goal of this study was to identify clusters of patients based on similar comorbidity profiles and to determine whether these clusters were associated with rate of lung function decline and/or mortality. Methods Patients with a major fibrotic ILD (idiopathic pulmonary fibrosis (IPF), fibrotic hypersensitivity pneumonitis, connective tissue disease-associated ILD, and unclassifiable ILD) from the CAnadian REgistry for Pulmonary Fibrosis (CARE-PF) were included. Hierarchical agglomerative clustering of comorbidities, age, sex, and smoking pack-years was conducted for each ILD subtype to identify combinations of these features that frequently occurred together in patients. The association between clusters and change in lung function over time was determined using linear mixed effects modeling, with adjustment for age, sex, and smoking pack-years. Kaplan Meier curves were used to assess differences in survival between the clusters. Results Discrete clusters were identified within each fibrotic ILD. In IPF, males with obstructive sleep apnea (OSA) had more rapid decline in FVC %-predicted (− 11.9% per year [95% CI − 15.3, − 8.5]) compared to females without any comorbidities (− 8.1% per year [95% CI − 13.6, − 2.7]; p = 0.03). Females without comorbidities also had significantly longer survival compared to all other IPF clusters. There were no significant differences in rate of lung function decline or survival between clusters in the other fibrotic ILD subtypes. Conclusions The combination of male sex and OSA may portend worse outcomes in IPF. Further research is required to elucidate the interplay between sex and comorbidities in ILD, as well as the role of OSA in ILD disease progression.

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“…A review by Dowman et al [37] linked improved physical activity in the context of pulmonary rehabilitation with improved HRQL outcomes in ILD patients. Weight loss is common among ILD patients and a study by Pugashetti et al [38] found an association between weight loss and mortality risk in IPF patients. On the contrary, another study linked higher baseline BMI values to increased frequency of acute exacerbations [39].…”

Section: Discussionmentioning

confidence: 99%

Determinants of health-related quality of life decline in interstitial lung disease

Maqhuzu

Szentes

Kreuter

et al. 2020

Health Qual Life Outcomes

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Background Health-related quality of life (HRQL) in interstitial lung disease (ILD) patients is impaired. We aimed to identify baseline predictors for HRQL decline within a 12-month observation period. Methods We analyzed 194 ILD patients from two German ILD-centers in the observational HILDA study. We employed the disease-specific King’s Brief Interstitial Lung Disease questionnaire (K-BILD) with the subdomains ‘psychological impact’, ‘chest symptoms’ and ‘breathlessness and activities’, and the generic EQ-5D Visual Analog Scale (VAS). We evaluated how many patients experienced a clinically meaningful decline in HRQL. Subsequently, we investigated medical and sociodemographic factors as potential predictors of HRQL deterioration. Results Within the study population (34.0% male, Ø age 61.7) mean HRQL scores hardly changed between baseline and follow up (K-BILD: 52.8 vs. 52.5 | VAS: 60.0 vs. 57.3). On the intra-individual level, 30.4% (n = 59) experienced a clinically relevant deterioration in K-BILD total score and 35.4% (n = 68) in VAS. Lower baseline forced vital capacity (FVC) % predicted determined HRQL decline in K-BILD total score (ß-coefficient: − 0.02, p = 0.007), VAS (ß-coefficient: − 0.03, p < 0.0001), and in the subdomain ‘psychological impact’ (ß-coefficient: − 0.02, p = 0.014). Lower baseline diffusing capacity of carbon monoxide (DLCO) % predicted determined deterioration in ‘breathlessness and activities’ (ß-coefficient: − 0.04, p = 0.003) and ‘chest symptoms’ (ß-coefficient: − 0.04, p = 0.002). Additionally, increasing age predicted decline in ‘psychological impact’ (ß-coefficient: 0.06, p < 0.007). Conclusion Around a third of ILD patients experienced a clinically relevant HRQL deterioration in a 12-month period, which was associated with baseline lung function values in all K-BILD domains. As lung function values are time-dependent variables with possible improvements, in contrast to age and ILD subtype, it, thus, seems important to improve lung function and prevent its decline in order to maintain HRQL on the possibly highest level.

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Weight Loss as a Predictor of Mortality in Patients with Interstitial Lung Disease

Cited by 12 publications

References 0 publications

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.

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.

A cluster-based analysis evaluating the impact of comorbidities in fibrotic interstitial lung disease

Determinants of health-related quality of life decline in interstitial lung disease

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