In-hospital mortality trends among patients with idiopathic pulmonary fibrosis in the United States between 2013-2017: a comparison of academic and non-academic programs

Shehabaldin Alqalyoobi,Justin M Oldham,Evans R Fernández Pérez

doi:10.1186/s12890-020-01328-y

Abstract

BackgroundIdiopathic pulmonary fibrosis (IPF) is a devastating condition characterized by progressive lung function decline and early mortality. While early accurate diagnosis is essential for IPF treatment, data evaluating the impact of hospital academic status on IPF-related mortality remains limited. Here we examined in-hospital mortality trends for patients with IPF from 2013 to 2017. We hypothesized that in-hospital IPF mortality would be influenced by hospital academic setting.MethodsHospitalization data was extracted from the National Inpatient Sample (NIS) for subjects with an international classification of disease code for IPF. In-hospital mortality stratified by hospital setting (academic versus non-academic) was the primary outcome of interest, with secondary analyses performed for subgroups with and without respiratory failure and requiring mechanical ventilation. Predictors of mortality were then assessed.ResultsAmong 93,680 patients with IPF requiring hospitalization, 58,450 (62.4%) were admitted to academic institutions. In-hospital mortality decreased significantly in those admitted to an academic hospital (p < 0.001) but remained unchanged in patients admitted to a non-academic hospital. A plateau in-hospital mortality was observed among all hospitalized patients (p = 0.12), with a significant decrease observed for patients with admitted respiratory failure (p < 0.001) and those placed on mechanic ventilation (p < 0.001).ConclusionIn-hospital mortality decreased significantly for patients with IPF admitted to an academic hospital, suggesting that management strategies may differ by hospital setting. Mortality among those with respiratory failure and those requiring mechanical ventilation has dropped significantly. Our findings may underscore the importance of promoting early referral to an academic institution and adherence to international treatment guidelines.

Highlights

Idiopathic pulmonary fibrosis (IPF) is a devastating condition characterized by progressive lung function decline and early mortality
We report an incidence of allcause hospitalizations among patients with IPF of 44.6 per 100,000 hospitalizations for 2013 and 63.4 per 100, 000 hospitalizations for 2017 which increased by 42.2% over the five years (Fig. 2)
Those who are admitted to an academic institution had significantly more males and Black patients with a higher proportion of respiratory failure, obstructive sleep apnea, gastroesophageal reflux disease, low body mass index, obesity, new pulmonary embolism, pulmonary circulation disorders, and supplemental oxygen therapy use

Summary

Introduction

Idiopathic pulmonary fibrosis (IPF) is a devastating condition characterized by progressive lung function decline and early mortality. While acute exacerbations of IPF are difficult to characterize due to lack of an international classification of disease (ICD) code, IPF related hospitalizations have been suggested as a clinically meaningful endpoint [2,3,4,5,6]. This is supported by prior work showing respiratory hospitalization is associated with increased short-term mortality risk in patients with IPF [7]. Anti-fibrotic therapies nintedanib and pirfenidone have both been shown to slow lung function decline in patients with IPF [4, 9] and recent analyses suggest they may improve survival, [10,11,12] reduce hospitalization, [4, 10] and exacerbation risk [4, 13]

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