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Outcomes after Hospitalization in Idiopathic Pulmonary Fibrosis: a cohort study.
Chest. 2014 Sep 4;
Authors: Brown AW, Fischer CP, Shlobin OA, Buhr RG, Ahmad S, Weir NA, Nathan SD
Abstract
Abstract: Background:The outcomes of IPF patients who undergo hospitalization have not been well characterized. We sought to evaluate the frequency and impact of all-cause as well as respiratory-related hospitalizations on the subsequent course and survival of patients with IPF. Methods:The records of IPF patients evaluated at a tertiary center were examined for cause and duration of hospitalization. Data on subsequent patient outcomes was collated. Results:The IPF cohort consisted of 592 patients, 25.3% of whom were hospitalized subsequent to their IPF diagnosis. A respiratory-related etiology accounted for 77.3% of these hospitalizations. The median transplant-free survival for all patients was 23.3 [IQR:7.6-63.6] months from time of consultation. Transplant-free survival after hospital admission was much worse for patients with a respiratory hospitalization compared to a non-respiratory hospitalization (median survival: 2.8 [IQR: 0.63-16.2] vs. 27.7 [IQR: 7.4-59.6] months, p=0.0004). Multivariate analyses demonstrated that both all-cause and respiratory-related hospitalizations were strongly associated with mortality after adjusting for baseline demographics. Among patients with a respiratory hospitalization, 22.4% died while in the hospital while 16.4% eventually went onto lung transplantation. Conclusions:Hospitalizations are common events in IPF patients. Most hospitalizations are respiratory-related and are associated with high in-hospital mortality and limited survival beyond discharge. Both all-cause hospitalization and respiratory hospitalization are associated with mortality, and therefore either could be utilized as an endpoint in IPF clinical trials.
Background: The outcomes of IPF patients who undergo hospitalization have not been well characterized. We sought to evaluate the frequency and impact of all-cause as well as respiratory-related hospitalizations on the subsequent course and survival of patients with IPF.
Methods: The records of IPF patients evaluated at a tertiary center were examined for cause and duration of hospitalization. Data on subsequent patient outcomes was collated.
Results: The IPF cohort consisted of 592 patients, 25.3% of whom were hospitalized subsequent to their IPF diagnosis. A respiratory-related etiology accounted for 77.3% of these hospitalizations. The median transplant-free survival for all patients was 23.3 [IQR:7.6-63.6] months from time of consultation. Transplant-free survival after hospital admission was much worse for patients with a respiratory hospitalization compared to a non-respiratory hospitalization (median survival: 2.8 [IQR: 0.63-16.2] vs. 27.7 [IQR: 7.4-59.6] months, p=0.0004). Multivariate analyses demonstrated that both all-cause and respiratory-related hospitalizations were strongly associated with mortality after adjusting for baseline demographics. Among patients with a respiratory hospitalization, 22.4% died while in the hospital while 16.4% eventually went onto lung transplantation.
Conclusions: Hospitalizations are common events in IPF patients. Most hospitalizations are respiratory-related and are associated with high in-hospital mortality and limited survival beyond discharge. Both all-cause hospitalization and respiratory hospitalization are associated with mortality, and therefore either could be utilized as an endpoint in IPF clinical trials.
PMID: 25188694 [PubMed - as supplied by publisher]