Prognostic factors for hospital mortality in patients with idiopathic pulmonary fibrosis

Abstract Background: The prognostic factors for hospital mortality in patients with idiopathic pulmonary fibrosis (IPF) have not been characterised well. We aimed to determine the impact of respiratory hospitalisation on patient outcomes and the prognostic predictors for hospital mortality. Methods: Data from patients with IPF was collected and analysed from two cohorts, TaiwanNational Health Insurance Research Database (NHIRD) between 2001 and 2011 and a national medical centre (NMC)between 2001and 2015. Results: 122 patients in NHIRD cohort were recruited. The median survival was lower in patients with respiratory hospitalisation (25/122, 29.8%) compared with non-respiratory hospitalisation(59/122, 48.4%) in NHIRD cohort (2.3 years vs non-respiratory 9 years, p =0.007). In NMC cohort (N=47), patients with acute respiratory deterioration (ARD) hospitalisation (30/47,63.8%) compared with non-ARD hospitalisation (17/47, 36.2%) had poor survival (0.9 monthsvs 29.6 months, p <0.001). The differences in survival between two cohorts were associated with age, causes of hospitalisation, mechanical ventilation and comorbidities. The patients hospitalised for ARD had statistically higher GAP score, lower oxygenation, higher C-reactive protein levels, higher neutrophil counts and lower serum albumin level compared to those non-ARD hospitalisation. For both in-hospital and 1 year mortality, multivariate analysis adjusting for patient characteristics confirmed the independent predictive factors were steroid pulse therapy, acute exacerbation and mechanical ventilation. Conclusions: The respiratory hospitalisation negatively impacted patient outcomes, and the independent prognostic factors may be utilised to refine the management in patients with IPF.