Regardless of IPF Diagnosis, Acute Respiratory Worsening Is an Independent Factor That Increases Morbidity, Study Suggests

Regardless of IPF Diagnosis, Acute Respiratory Worsening Is an Independent Factor That Increases Morbidity, Study Suggests

In a recent study, “Patients with Fibrotic Interstitial Lung Disease Hospitalized for Acute Respiratory Worsening: A Large Cohort Analysis,” published in the CHEST journal, researchers reported that acute respiratory worsening increases morbidity regardless of an idiopathic pulmonary fibrosis (IPF) diagnosis.

Patients with fibrotic interstitial lung disease (a group of lung disorders in which the deep lung tissues become inflamed; IPF is the most common type), commonly develop acute respiratory worsening. However, the frequency and its implications to IPF and non-IPF patients are poorly understood.

Now, a team of clinicians reviewed all cases of patients with fibrotic interstitial lung disease hospitalized at the Mayo Clinic in Rochester, Minnesota, with acute respiratory worsening from 2000 to 2014. The team defined acute respiratory worsening as “any worsening of respiratory symptoms with new or worsened hypoxemia or hypercapnia within 30 days of admission,” with hypoxemia meaning an abnormally low concentration of oxygen in the blood, and hypercapnia being a condition characterized by abnormally elevated carbon dioxide levels in the blood.

In total, the team analyzed 220 patients divided into two groups: 100 with an IPF diagnosis and 120 non-IPF, comprising a total of 311 hospital admissions for acute respiratory worsening.

Researchers found that 52 percent of the hospital admissions were for suspected acute exacerbation, 20 percent were for infection, and 15 percent were for sub-acute progression of disease. In-hospital mortality rates registered no differences between IPF compared to non-IPF patients, with IPF registering 55 percent, and non-IPF patients 45 percent. This mortality rate was, however, significantly worse in suspected acute exacerbation admission cases. After discharge, the survival rate for patients with suspected acute exacerbation and patients admitted with secondary characteristics of acute respiratory worsening was similar in IPF and non-IPF groups.

The study’s lead author, Teng Moua, MD, from the Mayo Clinic’s division of pulmonary and critical care medicine, and colleagues concluded in a news release, “Our findings suggest significant morbidity for all [fibrotic interstitial lung disease (f-ILD)] patients hospitalized with [acute respiratory worsening]. While focus in the initial management of these patients may be to delineate idiopathic pulmonary fibrosis from non-IPF disease and acute exacerbation from known causes of acute respiratory worsening, overall in-hospital mortality appears to be no different between the two groups.”

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