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Original Research: Diffuse Lung Disease |

Outcomes After Hospitalization in Idiopathic Pulmonary FibrosisHospitalization in Idiopathic Pulmonary Fibrosis: A Cohort Study

A. Whitney Brown, MD; Chelsea P. Fischer, BS; Oksana A. Shlobin, MD; Russell G. Buhr, MD; Shahzad Ahmad, MD; Nargues A. Weir, MD, FCCP; Steven D. Nathan, MD, FCCP
Author and Funding Information

From the Advanced Lung Disease and Transplant Program (Drs Brown, Shlobin, Ahmad, Weir, and Nathan and Ms Fischer), Department of Medicine, Inova Fairfax Hospital, Falls Church, VA; and the Department of Medicine (Dr Buhr), University of California at Los Angeles, Los Angeles, CA.

CORRESPONDENCE TO: Steven D. Nathan, MD, FCCP, Advanced Lung Disease and Transplant Program, Inova Heart and Vascular Institute, 3300 Gallows Rd, Falls Church, VA 22042; e-mail: steven.nathan@inova.org


FUNDING/SUPPORT: The authors have reported to CHEST that no funding was received for this study.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2015;147(1):173-179. doi:10.1378/chest.13-2424
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OBJECTIVE:  The outcomes of patients with idiopathic pulmonary fibrosis (IPF) who undergo hospitalization have not been well characterized. We sought to determine the frequency of all-cause and respiratory-related hospitalizations and to evaluate their impact on the subsequent course and survival of patients with IPF.

METHODS:  The records of patients with IPF evaluated at a tertiary center were examined for the cause and duration of hospitalization. Data on subsequent patient outcomes were collated.

RESULTS:  The IPF cohort consisted of 592 patients, 25.3% of whom were hospitalized subsequent to their IPF diagnosis. A respiratory-related cause accounted for 77.3% of these hospitalizations. The median transplant-free survival for all patients was 23.3 months (interquartile range [IQR], 7.6-63.6 months) from the time of consultation. Transplant-free survival after hospital admission was much lower for patients with a respiratory hospitalization compared with those with a nonrespiratory hospitalization (median survival, 2.8 months [IQR, 0.63-16.2 months] vs 27.7 months [IQR, 7.4-59.6 months]; P = .0004). Multivariate analyses demonstrated that both all-cause and respiratory-related hospitalizations were strongly associated with mortality after adjusting for baseline demographics. Among patients with a respiratory hospitalization, 22.4% died while in the hospital, whereas 16.4% eventually went on to lung transplantation.

CONCLUSIONS:  Hospitalizations are common events in patients with IPF. Most hospitalizations are respiratory-related and are associated with high in-hospital mortality and limited survival beyond discharge. Both all-cause and respiratory hospitalizations are associated with mortality, and therefore, either could be used as an end point in IPF clinical trials.

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