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. 2017 Aug 5;73(7):618-625.
doi: 10.1136/thoraxjnl-2017-210109. Online ahead of print.

Late mortality after acute hypoxic respiratory failure

Hallie C Prescott  1   2   3 , Michael W Sjoding  1   2 , Kenneth M Langa  1   2   3   4 , Theodore J Iwashyna  1   2   3   4 , Daniel F McAuley  5
Affiliations

Late mortality after acute hypoxic respiratory failure

Hallie C Prescott et al. Thorax. .

Abstract

Background: Acute hypoxic respiratory failure (AHRF) is associated with significant acute mortality. It is unclear whether later mortality is predominantly driven by pre-existing comorbid disease, the acute inciting event or is the result of AHRF itself.

Methods: Observational cohort study of elderly US Health and Retirement Study (HRS) participants in fee-for-service Medicare (1998-2012). Patients hospitalised with AHRF were matched 1:1 to otherwise similar adults who were not currently hospitalised and separately to patients hospitalised with acute inciting events (pneumonia, non-pulmonary infection, aspiration, trauma, pancreatitis) that may result in AHRF, here termed at-risk hospitalisations. The primary outcome was late mortality-death in the 31 days to 2 years following hospital admission.

Results: Among 15 075 HRS participants, we identified 1268 AHRF and 13 117 at-risk hospitalisations. AHRF hospitalisations were matched to 1157 non-hospitalised adults and 1017 at-risk hospitalisations. Among patients who survived at least 30 days, AHRF was associated with a 24.4% (95%CI 19.9% to 28.9%, p<0.001) absolute increase in late mortality relative to adults not currently hospitalised and a 6.7% (95%CI 1.7% to 11.7%, p=0.01) increase relative to adults hospitalised with acute inciting event(s) alone. At-risk hospitalisation explained 71.2% of the increased odds of late mortality, whereas the development of AHRF itself explained 28.8%. Risk for death was equivalent to at-risk hospitalisation beyond 90 days, but remained elevated for more than 1 year compared with non-hospitalised controls.

Conclusions: In this national sample of older Americans, approximately one in four survivors with AHRF had a late death not explained by pre-AHRF health status. More than 70% of this increased risk was associated with hospitalisation for acute inciting events, while 30% was associated with hypoxemic respiratory failure.

Keywords: Ards; Assisted Ventilation; Clinical Epidemiology; Respiratory Infection.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Cohort flow.
Figure 2
Figure 2
Risk of death over time. The risk of death over time is shown for the AHRF cohort (in red), non-hospitalised cohort (in green) and at-risk cohort (in blue). The shaded area represents the 95% CI. AHRF, acute hypoxic respiratory failure.
Figure 3
Figure 3
Kaplan-Meier survival curves for AHRF cohorts versus matched comparison cohorts showing long-term survival of patients who survived at least 30 days after this match day. The proportion surviving over time is shown for the AHRF cohort (in red), non-hospitalised cohort (in green) and at-risk cohort (in blue). The shaded area represents the 95% CI.AHRF, acute hypoxic respiratory failure.
Figure 4
Figure 4
Absolute excess late mortality of AHRF versus at-risk hospitalisations, stratified by subgroup. AHRF, acute hypoxic respiratory failure.
See this image and copyright information in PMC

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