A retrospective study of in-hospital mortality in patients with idiopathic pulmonary fibrosis between 2015 and 2018

Abstract

Hospitalizations are common in patients with idiopathic pulmonary fibrosis (IPF) and are associated with high mortality. We used data from the Premier Healthcare Database to determine in-hospital mortality rates and the factors associated with in-hospital mortality in patients with IPF in the era of approved antifibrotic drugs.The Premier Healthcare Database is a detailed and broadly representative database of hospital admissions and discharges in the US. Patients with IPF who were hospitalized between 1 January 2015 and 28 February 2018 were identified using a diagnostic algorithm comprising International Classification of Diseases -9 and International Classification of Diseases -10 diagnostic codes and billing data. Associations between patient-, hospital- and treatment-related factors and a composite outcome of death during the index visit, lung transplant during the index visit but >1 day after admission, or death during a readmission within 90 days of the index visit were analyzed using logistic regression.The cohort comprised 9667 hospitalized patients with IPF. In total, 1414 patients (14.6%) met the composite outcome: 1036 (10.7%) died during the index visit, 371 (3.8%) died during a readmission within 90 days; 7 (0.1%) underwent lung transplant >1 day after admission. Factors significantly associated with a higher risk of the composite outcome included mechanical ventilation (odds ratio 6.41 [95% CI: 5.24, 7.84]), admission to the intensive care unit (1.73 [1.49, 2.00]), attendance by a critical care physician (2.12 [1.33, 3.38]), older age (1.20 [1.12, 1.28] per 10-year increase), and use of intravenous steroids (1.16 [1.00, 1.34]), intravenous antibiotics (1.49 [1.22, 1.83]) and opioids (3.41 [2.95, 3.93]). Factors significantly associated with a lower risk of the composite outcome included female sex (0.70 [0.61, 0.80]), comorbid chronic obstructive pulmonary disease (0.69 [0.60, 0.78]), attendance by a family medicine physician (0.67 [0.48, 0.94]) or internal medicine physician (0.59 [0.46, 0.75]), and use of oral steroids (0.62 [0.51, 0.77]), statins (0.76 [0.67, 0.87]) and proton pump inhibitors (0.80 [0.70, 0.92]).In conclusion, patients with IPF are at risk of mortality during a hospital stay or readmission within 90 days, particularly those who receive mechanical ventilation.

Figure 1

Concurrent diagnoses among hospitalized patients with IPF from January 1, 2015 to February 28, 2018. COPD = chronic obstructive pulmonary disease, GERD = gastroesophageal reflux disease.

Figure 2

Diagnostic tests and interventions among hospitalized patients with IPF from January 1, 2015 to February 28, 2018. HRCT = high-resolution computed tomography, ICU = intensive care unit.

Figure 3

Medication use among hospitalized patients with IPF from January 1, 2015 to February 28, 2018.

Figure 4

Associations between patient-, hospital- and treatment-related factors and in-hospital mortality or lung transplantation in patients with IPF from January 1, 2015 to February 28, 2018. COPD = chronic obstructive pulmonary disease, ICU = intensive care unit.

Figure 5

Estimated lengths of stay in hospital among patients with IPF from January 1, 2015 to February 28, 2018 based on patient-, hospital- and treatment-related factors. COPD = chronic obstructive pulmonary disease, HRCT = high-resolution computed tomography, intensive care unit.

Figure 6

Associations between patient-, hospital- and treatment-related factors and 90-day readmission in patients with IPF from January 1, 2015 to February 28, 2018. HRCT = high-resolution computed tomography.