Abstract
BackgroundWhether acute respiratory failure in patients with interstitial lung disease is reversible remains uncertain. Consequently, indications for extracorporeal membrane oxygenation in these patients are still controversial, except as a bridge to lung transplantation. The objective of this study was to clarify in-hospital mortality and prognostic factors in interstitial lung disease patients undergoing extracorporeal membrane oxygenation.MethodsIn this case–control study using the Japanese Diagnosis Procedure Combination database, hospitalized interstitial lung disease patients receiving invasive mechanical ventilation and extracorporeal membrane oxygenation from 2010 to 2017 were reviewed. Patients’ characteristics and treatment regimens were compared between survivors and non-survivors to identify prognostic factors. To avoid selection biases, patients treated with extracorporeal membrane oxygenation as a bridge to lung transplantation were excluded.ResultsA total of 164 interstitial lung disease patients receiving extracorporeal membrane oxygenation were included. Their in-hospital mortality was 74.4% (122/164). Compared with survivors, non-survivors were older and received high-dose cyclophosphamide, protease inhibitors, and antifungal drugs more frequently, but macrolides and anti-influenza drugs less frequently. On multivariate analysis, the following factors were associated with in-hospital mortality: advanced age (odds ratio [OR] 1.043; 95% confidence interval [CI] 1.009–1.078), non-use of macrolides (OR 0.305; 95% CI 0.134–0.698), and use of antifungal drugs (OR 2.416; 95% CI 1.025–5.696).ConclusionsApproximately three-quarters of interstitial lung disease patients undergoing extracorporeal membrane oxygenation died in hospital. Moreover, advanced age, non-use of macrolides, and use of antifungal drugs were found to correlate with a poor prognosis.
Highlights
Whether acute respiratory failure in patients with interstitial lung disease is reversible remains uncer‐ tain
Data are expressed as number of patients (%) and median (IQR) BMI body mass index, interquartile range (IQR) interquartilerange, n/a not assessed
Data are expressed as number of patients (%) CHDF Continuous hemodialysis filtration, Extracorporeal membrane oxygenation (ECMO) extracorporeal membrane oxygenation, MRSA methicillin-resistant Staphylococcus aureus
Summary
Whether acute respiratory failure in patients with interstitial lung disease is reversible remains uncer‐ tain. Indications for extracorporeal membrane oxygenation in these patients are still controversial, except as a bridge to lung transplantation. The objective of this study was to clarify in-hospital mortality and prognos‐ tic factors in interstitial lung disease patients undergoing extracorporeal membrane oxygenation. Regardless of the type of interstitial lung disease (ILD), the associated acute respiratory failure (ARF) leads to a poor prognosis, especially in patients requiring invasive mechanical ventilation (IMV) [1,2,3]. ECMO therapy is indicated in patients with potentially reversible causes of respiratory failure or those awaiting lung transplantation [7, 8]. The aim of this study was to elucidate the mortality rate and identify prognostic factors in these patients by using nationwide data from the Japanese Diagnosis Procedure Combination (DPC) database
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