Repeat Hospitalizations in IPF Patients Linked to Poor Survival in Study

Repeat hospitalizations for respiratory problems in people with chronic idiopathic interstitial pneumonia (c-IIP) — a group of chronic lung diseases that also include idiopathic pulmonary fibrosis (IPF) — are associated with poor long-term survival, a study reported.

The study, “Characteristics of patients with chronic idiopathic interstitial pneumonia undergoing repeated respiratory-related hospitalizations: A retrospective cohort study,” was published in the journal PLOS One.

IPF is a chronic disease of unknown origin that leads to the formation of scar tissue in the lungs, making it hard for patients to breathe.

Several studies suggest that respiratory insufficiency due to disease progression is the most frequent cause of death among IPF patients. However, recent studies indicate that lung infections are a common cause for repeated hospitalizations and death in IPF patients.

“Some patients with IPF undergo several RHs [respiratory-related hospitalizations] during their clinical course. However, the characteristics of patients who undergo repeated RHs remain unknown,” the investigators wrote.

To better identify patients with successive hospitalization, researchers at Kindai University in Japan reviewed the medical records of c-IIP patients who had been hospitalized for respiratory-related causes.

All patients included in the study were admitted to the Kindai University Hospital, in Japan, between January 2008 and December 2018.

Over that time, 243 c-IIP patients — 177 men and 66 women, mean age of 74.8 — were hospitalized 544 times for respiratory-related causes. Of these, 138 had a definitive diagnosis of IPF, while the remaining 105 had an unconfirmed diagnosis of c-IIP.

Acute respiratory exacerbation (a sudden aggravation of disease symptoms) was the most common reason a first hospitalization — reported in nearly half (48.1%) of the patients. This was followed by lung infections, which were observed in about one-third (32.5%) of this group.

Respiratory infections were the most common cause of subsequent hospitalizations.

As the number of respiratory-related hospitalizations increased, so did the percentage of hospital admissions due to lung infections, while the proportion of admissions caused by acute exacerbations decreased, the study reported.

The in-hospital and 90-day mortality rates seen in the first 243 hospitalizations were 14.8% and 19.3%, respectively. Both mortality rates tended to rise over time in patients with repeat hospitalizations for lung infections, but not among those who had been admitted multiple times for acute flares.

Additional analyses found that patients  hospitalized multiple times had poorer long-term survival compared to those who had been hospitalized only once.

Overall, “the mortality of patients who were hospitalized because of respiratory-related causes was high. Pulmonary infections, as well as acute exacerbations, accounted for a large proportion of the causes of RH in patients with c-IIP,” the researchers wrote.

“Repeated RH is associated with subsequent poor long-term mortality,” they concluded.