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. 2024 Jan 4;25(1):5.
doi: 10.1186/s12931-023-02588-y.

Hospitalisation patterns in interstitial lung diseases: data from the EXCITING-ILD registry

Katharina Buschulte  1 , Hans-Joachim Kabitz  2 , Lars Hagmeyer  3 , Peter Hammerl  4 , Albert Esselmann  5 , Conrad Wiederhold  6 , Dirk Skowasch  7 , Christoph Stolpe  8 , Marcus Joest  9 , Stefan Veitshans  10 , Marc Höffgen  11 , Phillen Maqhuzu  12 , Larissa Schwarzkopf  12   13 , Andreas Hellmann  14 , Michael Pfeifer  15 , Jürgen Behr  16 , Rainer Karpavicius  17 , Andreas Günther  18 , Markus Polke  19 , Philipp Höger  19 , Vivien Somogyi  20 , Christoph Lederer  19 , Philipp Markart  18   21 , Michael Kreuter  22
Affiliations

Hospitalisation patterns in interstitial lung diseases: data from the EXCITING-ILD registry

Katharina Buschulte et al. Respir Res. .

Abstract

Background: Interstitial lung diseases (ILD) comprise a heterogeneous group of mainly chronic lung diseases with more than 200 entities and relevant differences in disease course and prognosis. Little data is available on hospitalisation patterns in ILD.

Methods: The EXCITING-ILD (Exploring Clinical and Epidemiological Characteristics of Interstitial Lung Diseases) registry was analysed for hospitalisations. Reasons for hospitalisation were classified as all cause, ILD-related and respiratory hospitalisations, and patients were analysed for frequency of hospitalisations, time to first non-elective hospitalisation, mortality and progression-free survival. Additionally, the risk for hospitalisation according to GAP index and ILD subtype was calculated by Cox proportional-hazard models as well as influencing factors on prediction of hospitalisation by logistic regression with forward selection.

Results: In total, 601 patients were included. 1210 hospitalisations were recorded during the 6 months prior to registry inclusion until the last study visit. 800 (66.1%) were ILD-related, 59.3% of admissions were registered in the first year after inclusion. Mortality was associated with all cause, ILD-related and respiratory-related hospitalisation. Risk factors for hospitalisation were advanced disease (GAP Index stages II and III) and CTD (connective tissue disease)-ILDs. All cause hospitalisations were associated with pulmonary hypertension (OR 2.53, p = 0.005). ILD-related hospitalisations were associated with unclassifiable ILD and concomitant emphysema (OR = 2.133, p = 0.001) as well as with other granulomatous ILDs and a positive smoking status (OR = 3.082, p = 0.005).

Conclusion: Our results represent a crucial contribution in understanding predisposing factors for hospitalisation in ILD and its major impact on mortality. Further studies to characterize the most vulnerable patient group as well as approaches to prevent hospitalisations are warranted.

Keywords: Hospitalisation; ILD; IPF; Prognosis; Risk factors.

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Conflict of interest statement

KB received payment for lectures from Boehringer Ingelheim and a grant from Sarkoidose-Netzwerk e.V. DS reports fees for lectures or consultations from AstraZeneca, Boehringer Ingelheim, Chiesi, GSK, Janssen, MSD, Sanofi, all outside the submitted work. CS reports fees for lectures GSK, AstraZeneca, Boehringer Ingelheim, Berlin Chemie. MJ reports fees for lectures or consultations from AstraZeneca, Bencard, Boehringer Ingelheim, GSK, HAL Allergy, Sanofi, all outside the submitted work. SV reports fees from Berlin Chemie, GSK, Lilly and Boehringer-Ingelheim. JB reports personal fees for lectures and consulting from Astra-Zeneca, Biogen, Boehringer-Ingelheim, BMS, Ferrer, Novartis, Roche, and Sanofi-Genzyme. MP has received payment or honoraria for lectures, presentations or educational events from Boehringer Ingelheim and AstraZeneca. VS received support for attending meetings from CSL Behring. PM received fees for consulting and lectures from Boehringer-Ingelheim and Roche. MK reports grants, consulting fees, and payment for lectures from Boehringer Ingelheim and Roche. All other authors have nothing to disclose.

Figures

Fig. 1
Fig. 1
Time to first non-elective hospitalisation in months—Kaplan Meier curve. Time to first non-elective hospitalisation was defined as the first non-elective hospitalisation from inclusion to the registry (n= 322). Median time to first hospitalisation was 26 months
Fig. 2
Fig. 2
Time to ILD progression in months after definition A and B—Kaplan Meier curve. A ΔForced vital capacity (FVC) ≥ 10% or respiratory hospitalisation or death (n= 340); B ΔFVC ≥ 10% or all cause hospitalisation or death (n= 415)
Fig. 3
Fig. 3
Time to death—Kaplan Meier curve for years 0–10 since diagnosis by all cause hospitalisation. Patients who have reported at least one hospitalisation that started after inclusion date are counted as hospitalised (n= 337). Median time to event was 9.7 years (range 0.2–34.4 years)
Fig. 4
Fig. 4
Time to death—Kaplan Meier curve for years 0–10 since diagnosis by ILD-hospitalisation. Non-elective ILD-hospitalisation from date of inclusion were considered (n= 208). Median time to event was 7.3 years (range 0.2–34.4 years)
Fig. 5
Fig. 5
Time to death—Kaplan Meier curve for years 0–10 since diagnosis by respiratory hospitalisation. A respiratory hospitalisation was defined as exclusively non-elective caused by pneumonia, ILD exacerbation or pneumothorax (n= 152). Median time to event was 7.2 years (range 0.2–34.4 years)
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