Hospital outcomes in interstitial lung disease-related admissions: a multicentre retrospective study in the North West of England

  1. Laura White
  2. Jonathon Shaw
  3. Bethan Powell
  4. Nyan May Kyi
  5. Alicia Sou
  6. Gareth Hughes
  7. Dilanka Tilakaratne
  8. Conal Hayton
  9. Trishala Raj
  10. Vi Truong
  11. Nashwah Ismail
  12. Nawat Khanijoun
  13. Rebecca Huang
  14. Emma Hardy
  15. Mahzaib Babar
  16. Naayaab Khan
  17. Martin Regan
  18. Oby Okpala
  19. Ragavilasini Suresh
  20. Jerome McIntosh
  21. Amsal Amjad
  22. Mahum Sohail
  23. Zainab Aslam
  24. Amy Gadoud
  25. Timothy Gatheral
  26. Georges NgManKwong
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Abstract

Background

Interstitial lung diseases (ILD) are a heterogenous group of often progressive diseases which follow an unpredictable disease course. They frequently result in hospitalisations secondary to respiratory decompensations, termed ILD-related admissions. A proportion of these are due to an acute exacerbation (AEILD) – a clinically and radiologically significant event. All are associated with high mortality but are poorly characterised in real-world populations.

Aim

To evaluate mortality outcomes and associated risk factors following ILD-related hospital admissions in a UK multicentre cohort.

Methods

We conducted a multicentre retrospective cohort study of primary ICD10 coded admissions for ILD between 01.01.2017 and 31.12.2019 across 11 NHS hospitals in the North West of England. AEILD events were classified with clinical criteria based on a <30-day respiratory deterioration not secondary to cardiac failure, pulmonary embolism or pneumothorax. Primary outcome was time from admission to death. Statistical analyses included Kaplan-Meier survival and multivariate cox proportional hazards modelling.

Results

Of 938 admissions ILD-related admissions, 54.5% met AEILD criteria. Inpatient and 90-day was 16.0% and 40.2% respectively. Mean survival of the AEILD cohort was 439.91 days (95% CI 365.10 – 502.72 days) and other cohort 691.25 days (95% CI 599.60 – 782.90 days), with a statistically significant difference in survival (p <0.001). AEILD and pre-admission oxygen use were consistently associated with increased mortality. Conversely, White and Asian ethnicity were associated with reduced risk of 90-day all-cause mortality. Only 13.9% of admissions had documented palliative care input.

Conclusion

This is the one of the largest datasets assessing ILD-related admission outcomes. AEILD events were common and independently associated with high mortality. Findings highlight the need for earlier palliative involvement, improved risk stratification and targeted AEILD-specific research.

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